BILL ANALYSIS
Senate Research Center H.B. 2292
By: Wohlgemuth (Nelson)
Finance
5/24/2003
Committee Substitute
DIGEST AND PURPOSE
To achieve the cost savings and revenue necessary to finance certain
health and human services,
C.S.H.B. 2292 implements changes in health and human service policy
necessary to ensure that
Texas continues to serve its citizens who are most in need of health and
human service
assistance. This bill also reorganizes and consolidates the health and
human service agencies,
requires additional rebates for drug manufacturers purchasing drugs under
health and human
service programs, increases fraud detection and recovery, reforms the
regulatory burden on
providers of health and human services, and consolidates certain
transportation services and
enacts many other measures that are necessary to deal with the current
budget crisis.
RULEMAKING AUTHORITY (NEED TO UPDATE AND REVIEW AFTER ADDING AMENDMENTS)
Rulemaking authority is expressly granted to the executive commissioner of
health and human services in SECTION 1.03 (Section 531.0055, Government
Code), SECTION 1.06 (Section 531.0163, Government Code), SECTION 1.08
(Sections 531.409,Government Code), SECTION 1.09 (Sections 1001.028,
1001.051, 1001.052, 1001.053, 1001.054, 1001.056 and 1001.075, Health and
Safety Code), SECTION 1.11 (Section 40.002, Human Resources Code), SECTION
1.12 (Section 40.027, Human Resources Code), SECTION 1.13 (Sections
117.028, 117.051, 117.052, 117.053, 117.054, 117.056, 117.073, Human
Resources Code), SECTION 1.13A (Sections 161.028, 161.051, 161.052,
161.053, 161.054, 161.056, and 161.073, Human Resources Code), SECTION
2.04 (Section 531.0335, Government Code), and SECTION 2.24 (Section
231.113, Government Code) of this bill. Rulemaking authority is
transferred to the executive commissioner of health and human services in
SECTION 1.03 (Section 531.0055, Government Code).
Rulemaking authority is transferred to the executive commissioner of
health and human services in SECTION 1.19 (Transfers to the Department of
State Health Services), SECTION 1.20. (Transfers to the Department of
Family and Protective Services), SECTION 1.21. (Transfers to the
Department of Aging and Disability Services), and SECTION 1.21A.
(Transfers to the Department of Assistive and Rehabilitative Services).
Rulemaking authority is expressly granted to the Health and Human Services
Commission in
SECTION 1.07 (Section 531.0224, Government Code), SECTION 2.04 (Section
531.063,
Government Code), SECTION 2.09 (Section 531.068, Government Code), SECTION
2.14
(Section 531.073, Government Code), SECTION 2.15 (Section 531.074,
Government Code), SECTION 2.18 (Section 531.102, Government Code),SECTION
2.25 (Section 531.114, Government Code), SECTION 2.82 (Section 31.015,
Human Resources Code), SECTION 2.86 ( Section 32.024 Human Resources
Code), SECTION 2.87 (Section 32.025, Human Resources Code), and SECTION
2.88 (Section 32.026, Human Resources Code), SECTION 2.91 (Section 32.028,
Human Resources Code), SECTION 2.92 (Section 32.0291, Human Resources
Code), SECTION 2.94 (Section 32.0321, Human Resources Code), and SECTION
2.96 (Section 32.0462, Human Resources Code) of this bill. Rulemaking
authority is transferred to HHSC in SECTION 1.18 (Transfers to the Health
and Human Services Commission) of this bill
Rulemaking authority is expressly granted to the Texas Board of Health in
SECTION 2.75 (Section 773.071, Health and Safety Code) of this bill.
Rulemaking authority is expressly granted to the Texas Department of Human
Services in
SECTION 2.78 (Section 31.0031, Human Resources Code), and SECTION 2.79
(Section 31.0032, Human Resources Code).
Rulemaking authority is expressly granted to the Texas Workforce
Commission in SECTION 2.83 (Section 302.0038, Labor Code), to the
Interagency Council on Early Childhood Intervention in SECTION 2.103
(Section 73.0051, Human Resources Code), and to the Texas State Board of
Pharmacy in SECTION 2.115 (Section 562.1085, Occupations Code) of this
bill.
SECTION BY SECTION ANALYSIS
SECTION 1.01. (a) Amends Section 531.001(3), Government Code, is amended
by redefining "commissioner" as "executive commissioner."
(b) Reenacts Section 531.001(4), Government Code, as amended by Chapters
53, 957, and 1420, Acts of the 77th Legislature, Regular Session, 2001,
and amends it to add the Department of Aging and Disability Services, the
Department of State Health Services and the Department of Assistive and
Rehabilitative Services to the definition of "health and human services
agencies," and to rename and reference the Department of Family and
Protective Services rather than the Department of Protective and
Regulatory Services.
(c) Reenacts Section 531.001(4), Government Code, as amended by Chapters
53, 957, and 1420, Acts of the 77th Legislature, Regular Session, 2001,
and amends it to redefine "health and human services agencies" effective
on the date the agencies listed in Section 1.26 of this article are
abolished as provided by that section.
(d) Provides that a reference in law to the commissioner of health and
human services means the executive commissioner of the Health and Human
Services Commission.
SECTION 1.02. Amends Section 531.004, Government Code, to continue the
Health and
Human Services Commission (HHSC) until September 1, 2009, rather than 2007.
SECTION 1.02A. Amends Section 531.005, Government Code, as follows:
Sec. 531.005. New heading: EXECUTIVE COMMISSIONER. (a) Provides that HHSC
is governed by an executive commissioner of health and human services,
rather than a commissioner of health and human services, appointed by the
governor with the advice and consent of the senate.
(b) Requires the executive commissioner of health and human services to
be appointed without regard to race, color, disability, sex, religion,
age, or national origin.
SECTION 1.03. Amends Section 531.0055, Government Code, as follows:
Sec. 531.0055. New heading: EXECUTIVE COMMISSIONER: GENERAL RESPONSIBILITY
FOR HEALTH AND HUMAN SERVICES AGENCIES. (a) Redefines "agency director."
Deletes definition of "policymaking body."
(b) Requires HHSC to take certain actions.
(c) Deletes existing text relating to the implementation of HHSC's duties
under
Subsection (b) and existing text relating to certain sections as added by
Chapter
1045, Acts of the 75th Legislature, Regular Session, 1997. Makes a
nonsubstantive change.
(d) Requires HHSC to plan and implement an efficient and effective
centralized
system of administrative support services for health and human services
agencies.
Provides that the performance of administrative support services for
health and
human services agencies is the responsibility of HHSC. Provides that the
term
"administrative support services" includes, but is not limited to,
strategic planning
and evaluation, audit, legal, human resources, information resources,
purchasing,
contract management, financial management, and accounting services.
(e) Requires the executive commissioner of health and human services,
notwithstanding any other law, to adopt rules and policies for the
operation of and provision of health and human services by the health and
human services agencies. Requires the executive commissioner of health and
human services, in addition and as necessary to perform the functions
described by Subsections (b), (c), and (d) in implementation of applicable
policies established for an agency by the executive commissioner of health
and human services, rather than each agency's policymaking body, to
perform certain functions.
(f) Provides that the operational authority and responsibility of the
executive commissioner of health and human services for purposes of
Subsection (e) at each health and human services agency includes authority
over and responsibility for certain actions, policies, and systems.
(g) Provides that notwithstanding any other law, the operational authority
and responsibility of the executive commissioner of health and human
services for purposes of Subsection (e) at each health and human services
agency includes the authority and responsibility to adopt or approve,
subject to applicable limitations, any rate of payment or similar
provision required by law to be adopted or approved by the agency.
(h) Makes conforming changes.
(i) Provides that the agency director acts on behalf of the executive
commissioner of health and human services in performing the delegated
function and reports to the executive commissioner of health and human
services regarding the delegated function and any matter affecting agency
programs and operations.
(j) Requires, rather than authorizes, the executive commissioner of health
and human services to adopt rules to implement the executive
commissioner's authority under this section.
(k) Requires the executive commissioner of health and human services and
each agency director to enter into a memorandum of understanding in the
manner prescribed by Section 531.0163 that clearly defines certain
responsibilities of the agency director and the executive commissioner of
health and human services.
(l) Provides that the executive commissioner of health and human services,
rather than a policymaking body, has the authority to adopt policies and
rules governing the delivery of services to persons who are served by each
health and human services agency and the rights and duties of persons who
are served or regulated by each agency, notwithstanding any other law.
Deletes existing text relating to requiring the commissioner of health and
human services and each policymaking body to enter into a memorandum of
understanding that clearly defines the policymaking authority of the
policymaking body and the operational authority of the commissioner of
health and human services.
SECTION 1.04. Amends Section 531.0056, Government Code, as follows:
Sec. 531.0056. New heading: APPOINTMENT OF AGENCY DIRECTOR BY
EXECUTIVE COMMISSIONER. (a) Requires the executive commissioner of health
and human services, with the approval of the governor, to appoint an
agency director for each health and human services agency. Deletes
existing text relating to this section only applying to an agency director
employed by the commissioner of health and human services.
(b) Requires the agency director to serve at the pleasure of the executive
commissioner of health and human services. Deletes existing text relating
to authorizing an agency director employed by the commissioner of health
and human services to be employed only with the concurrence of the
agency's policymaking body and the approval of the governor.
(c) Requires the memorandum of understanding required by that section to
clearly
define the responsibilities of the agency director, in addition to the
requirements
of Section 531.0055(k)(1). Deletes existing text relating to requiring the
commissioner of health and human services and agency director to enter
into a
memorandum of understanding and authorizes establishing certain terms and
conditions of employment.
(d) and (e) Make conforming changes.
(f) Requires the executive commissioner of health and human services to
submit the evaluation to the governor not later than January 1 of each
even-numbered year. Deletes existing text relating to the commissioner of
health and human services submitting any recommendation regarding
employment of the agency director to the policymaking body.
Deletes existing Subsections (g) and (h).
SECTION 1.05. Amends Section 531.008, Government Code, as follows:
(a)-(b) Make conforming changes.
(c) Requires the executive commissioner of health and human services to
establish certain divisions and offices within HHSC.
SECTION 1.06. Amends Subchapter A, Chapter 531, Government Code, by adding
Sections
531.0161, 531.0162, and 531.0163, as follows:
Sec. 531.0161. NEGOTIATED RULEMAKING AND ALTERNATIVE DISPUTE
PROCEDURES. (a) and (b) Apply standard Sunset language regarding negotiated
rulemaking and alternative dispute procedures.
Sec. 531.0162. USE OF TECHNOLOGY. (a) Applies standard Sunset language
regarding the use of technology.
(b) Requires HHSC to develop and implement a policy described by
Subsection (a) in relation to HHSC's functions.
Sec. 531.0163. MEMORANDUM OF UNDERSTANDING. (a) Requires the
memorandum of understanding under Section 531.0055(k) to be adopted by the
executive commissioner of health and human services, by rule, in
accordance with the procedures prescribed by Subchapter B, Chapter 2001,
for adopting rules, except that the
requirements of Section 2001.033(a)(1)(A) or (C) do not apply with respect
to certain parts of the memorandum of understanding.
(b) Authorizes the memorandum of understanding to be amended only by
following the procedures prescribed under Subsection (a).
SECTION 1.07. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.0224, as follows:
Sec. 531.0224. PLANNING AND POLICY DIRECTION OF TEMPORARY
ASSISTANCE FOR NEEDY FAMILIES PROGRAM. Requires HHSC to take certain
actions, including adopting rules and standards governing the financial
assistance
program under Chapter 31, Human Resources Code (Financial Assistance and
Service
Programs), in consultation with the policy councils of the agencies that
operate the
program, including rules for determining eligibility for and the amount
and duration of an
earned income disregard.
SECTION 1.08. Amends Chapter 531, Government Code, by adding Subchapter K,
as follows:
SUBCHAPTER K. HEALTH AND HUMAN SERVICES COUNCIL
Sec. 531.401. DEFINITION. Defines "council."
Sec. 531.402. HEALTH AND HUMAN SERVICES COUNCIL. (a) Provides that the
Health and Human Services Council (HHS council) is created to assist the
executive commissioner of health and human services in developing rules
and policies for HHSC.
(b) Provides that the HHS council is composed of nine members of the
public appointed by the governor with the advice and consent of the
senate. Requires a person, to be eligible for appointment to the HHS
council, to have demonstrated an interest in and knowledge of problems and
available services related to the child health plan program, the financial
assistance program under Chapter 31, Human Resources Code, the medical
assistance program under Chapter 32 (Medical Assistance Programs), Human
Resources Code, or the nutritional assistance programs under Chapter 33
(Nutritional Assistance Programs), Human Resources Code.
(c) Requires the HHS council to study and make recommendations to the
executive commissioner of health and human services regarding the
management and operation of HHSC, including policies and rules governing
the delivery of services to persons who are served by HHSC and the rights
and duties of persons who are served or regulated by HHSC.
(d) Provides that Chapter 551 (Open Meetings), Government Code, applies to
the HHS council.
(e) Provides that Chapter 2110 (State Agency Advisory Committees),
Government Code, does not apply to the HHS council.
(f) Provides that a majority of the members of the HHS council constitute
a quorum for the transaction of business.
Sec. 531.403. APPOINTMENTS. Applies standard Sunset language regarding
appointments.
Sec. 531.404. TRAINING PROGRAM FOR COUNCIL MEMBERS.
Applies standard Sunset language regarding a training program for HHS
council members.
Sec. 531.405. TERMS. Sets forth the terms for HHS council members.
Sec. 531.406. VACANCY. Requires the governor by appointment to fill the
unexpired
term of a vacancy on the HHS council.
Sec. 531.407. PRESIDING OFFICER; OTHER OFFICERS; MEETINGS.
Applies standard Sunset language regarding the presiding officer, other
officers, and
meetings.
Sec. 531.408. REIMBURSEMENT FOR EXPENSES. Applies standard Sunset
language regarding reimbursement for expenses of HHS council members.
Sec. 531.409. PUBLIC INTEREST INFORMATION AND COMPLAINTS. Applies
standard Sunset language regarding public interest information and
complaints.
Sec. 531.410. PUBLIC ACCESS AND TESTIMONY. Applies standard Sunset language
regarding public access and testimony.
Sec. 531.411. POLICYMAKING AND MANAGEMENT RESPONSIBILITIES.
Applies standard Sunset language regarding the delineation of policymaking
and
management responsibilities.
SECTION 1.09. Amends the Health and Safety Code by adding Title 12, as
follows:
TITLE 12. HEALTH AND MENTAL HEALTH
CHAPTER 1001. DEPARTMENT OF STATE HEALTH SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1001.001. DEFINITIONS. Defines "commission," "commissioner,"
"council," "department," and "executive commissioner."
Sec. 1001.002. AGENCY. Provides that the Department of State Health
Services
(DSHS) is an agency of the state.
Sec. 1001.003. SUNSET PROVISION. Continues the Department of State Health
Services
until September 1, 2009.
[Reserves Sections 1001.004-1001.020 for expansion.]
SUBCHAPTER B. ADMINISTRATIVE PROVISIONS
Sec. 1001.021. STATE HEALTH SERVICES COUNCIL. (a) Provides that the State
Health Services Council (SHS council) is created to assist the executive
commissioner of health and human services in developing rules and policies
for DSHS.
(b) Sets forth the composition of and eligibility for the SHS council.
(c) Requires the SHS council to study and make recommendations to the
executive commissioner of health and human services regarding the
management and operation of DSHS, including policies and rules governing
the delivery of services to persons who are served by the department and
the rights and duties of persons who are served or regulated by DSHS.
(d) Provides that Chapter 551 (Open Meetings), Government Code, applies
to the SHS council.
(e) Provides that Chapter 2110 (State Agency Advisory Committees),
Government Code, does not apply to the SHS council.
(f) Provides that a majority of the members of the SHS council constitute
a quorum for the transaction of business.
Sec. 1001.022. APPOINTMENTS. Applies standard Sunset language regarding
appointments.
Sec. 1001.023. TRAINING PROGRAM FOR COUNCIL MEMBERS. Applies standard
Sunset language regarding a training program for SHS council members.
Sec. 1001.024. TERMS. Sets forth the terms of SHS council members.
Sec. 1001.025. VACANCY. Requires the governor by appointment to fill the
unexpired
term of a vacancy on the SHS council.
Sec. 1001.026. PRESIDING OFFICER; OTHER OFFICERS; MEETINGS. Applies
standard Sunset language regarding the presiding officer, other officers,
and
meetings.
Sec. 1001.027. REIMBURSEMENT FOR EXPENSES. Applies standard Sunset
language regarding reimbursement for expenses of SHS council members.
Sec. 1001.028. PUBLIC INTEREST INFORMATION AND COMPLAINTS. Applies
standard Sunset language regarding public interest information and
complaints.
Sec. 1001.029. PUBLIC ACCESS AND TESTIMONY. Applies standard
Sunset language regarding public access and testimony.
(c) Requires the executive commissioner of health and human services to
consider fully all written and oral submissions about a proposed rule.
Sec. 1001.030. POLICYMAKING AND MANAGEMENT RESPONSIBILITIES.
Applies standard Sunset language regarding the delineation of policymaking
and
management responsibilities.
Sec. 1001.031. ANNUAL REPORT. (a) Requires the commissioner of state
health services to file annually with the governor, the presiding officer
of each house of the legislature, and the executive commissioner of health
and human services a complete and detailed written report accounting for
all funds received and disbursed by DSHS during the preceding fiscal year.
(b) Requires the annual report to be in the form and be reported in the
time
provided by the General Appropriations Act.
Sec. 1001.032. OFFICES. Requires DSHS to maintain its central office in
Austin. Authorizes DSHS to maintain offices in other areas of the state as
necessary.
[Reserves Sections 1001.033-1001.050 for expansion.]
SUBCHAPTER C. PERSONNEL
Sec. 1001.051. COMMISSIONER. (a) Requires the executive commissioner of
health and human services to appoint with the approval of the governor a
commissioner of the Department of State Health Services (DSHS
commissioner). Provides that the DSHS commissioner is to be selected
according to education, training, experience, and demonstrated ability.
(b) Provides that the DSHS commissioner serves at the pleasure of the
executive commissioner of health and human services.
(c) Requires the DSHS commissioner, subject to the control of the
executive commissioner of health and human services, to act as DSHS's
chief administrative officer and as a liaison between DSHS and HHSC.
(d) Requires the DSHS commissioner to administer this chapter under
operational
policies established by the executive commissioner of health and human
services and in accordance with the memorandum of understanding under
Section 531.0055(k), Government Code, between the DSHS commissioner and
the executive commissioner of health and human services, as adopted by
rule.
Sec. 1001.052. PERSONNEL. Applies standard Sunset language regarding
personnel.
Sec. 1001.053. INFORMATION ABOUT QUALIFICATIONS AND STANDARDS OF
CONDUCT. Applies standard Sunset language regarding information about
qualifications and standards of conduct.
Sec. 1001.054. MERIT PAY. Applies standard Sunset language regarding merit
pay.
Sec. 1001.055. CAREER LADDER. Applies standard Sunset language regarding a
career ladder.
Sec. 1001.056. EQUAL EMPLOYMENT OPPORTUNITY POLICY. Applies standard
Sunset language regarding an equal employment and opportunity policy.
Sec. 1001.057. STATE EMPLOYEE INCENTIVE PROGRAM. Applies standard
Sunset language regarding a state employee incentive program.
[Reserves Sections 1001.058-1001.070 for expansion.]
SUBCHAPTER D. POWERS AND DUTIES OF DEPARTMENT
Sec. 1001.071. GENERAL POWERS AND DUTIES OF DEPARTMENT RELATED
TO HEALTH CARE. Provides that DSHS is responsible for administering
certain human services programs regarding the public health.
Sec. 1001.072. GENERAL POWERS AND DUTIES OF DEPARTMENT RELATED
TO MENTAL HEALTH. Provides that DSHS is responsible for administering
certain human services programs regarding mental health.
Sec. 1001.073. GENERAL POWERS AND DUTIES OF DEPARTMENT RELATED
TO SUBSTANCE ABUSE. Provides that DSHS is responsible for administering
certain human services programs regarding substance abuse.
Sec. 1001.074. INFORMATION REGARDING COMPLAINTS. (a) Requires DHS to
maintain a file on each written complaint filed with DSHS. Requires the
file to include certain information.
(b) Requires DSHS to provide to the person filing the complaint and to
each person who is a subject of the complaint a copy of the executive
commissioner of health and human services' and DSHS's policies and
procedures relating to complaint investigation and resolution.
(c) Requires DSHS, at least quarterly until final disposition of the
complaint, to notify the person filing the complaint and each person who
is a
subject of the complaint of the status of the investigation unless the
notice would
jeopardize an undercover investigation.
Sec. 1001.075. RULES. Authorizes the executive commissioner of health and
human services to adopt rules reasonably necessary for DSHS to administer
this chapter, consistent with the memorandum of understanding under
Section 531.0055(k), Government Code, between the DSHS commissioner and
the executive commissioner of health and human services, as adopted by
rule.
SECTION 1.10. Amends Section 40.001, Human Resources Code, by adding
Subdivisions (2-a) and (4-a) to define "council" and "executive
commissioner."
SECTION 1.11. Amends Section 40.002, Human Resources Code, as follows:
Sec. 40.002. New heading: DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES;
GENERAL DUTIES OF DEPARTMENT. (a) Provides that the Department of Family
and Protective Services (DFPS), rather than the Department of Protective
and Regulatory Services (DPRS), is composed of the council, rather than
board, the commissioner, rather than the executive director, an
administrative staff, and other officers and employees necessary to
efficiently carry out the purposes of this chapter.
(b) Requires DFPS, notwithstanding any other law, to perform certain
tasks.
(c) Provides that DFPS is the state agency designated to cooperate with
the federal government in the administration of programs under certain
federal
guidelines.
(d) Requires DFPS to cooperate with the United States Department of
Health and Human Services and other federal and state agencies in a
reasonable
manner and in conformity with the provisions of federal law and this
subtitle to
the extent necessary to qualify for federal assistance in the delivery of
services.
(e) Authorizes the executive commissioner of health and human services,
rather than DFPS, if DFPS determines that a provision of state law
governing DFPS conflicts with a provision of federal law, to adopt
policies and rules necessary to allow the state to receive and spend
federal matching funds to the fullest extent possible in accordance with
the federal statutes, this subtitle, and the state constitution and within
the limits of appropriated funds.
SECTION 1.12. Amends Sections 40.004, 40.021, 40.022, 40.0226, 40.024,
40.025, 40.026, and
40.027, Human Resources Code, as follows:
Sec. 40.004. New heading: PUBLIC INTEREST INFORMATION AND PUBLIC
ACCESS. (a)-(d) Applies standard Sunset language regarding public interest
information and public access.
Sec. 40.021. New heading: FAMILY AMD PROTECTIVE SERVICES COUNCIL. (a)
Provides that the Family and Protective Services Council (FPS council),
rather than the board, is created to assist the executive commissioner of
health and human services in developing rules and policies for DFPS.
Deletes existing language relating to the composition and appointment of
the board and the designation of the presiding officer of the board by the
governor.
(b) Sets forth the composition of and eligibility for FPS council members.
Deletes existing language relating to the eligibility requirements for
appointment to the board and the requirement for appointment of certain
members to represent the public.
(c) Requires the FPS council to study and make recommendations to the
executive commissioner of health and human services regarding the
management and operation of DFPS, including policies and rules governing
the delivery of services to persons who are served by DFPS and the rights
and duties of persons who are served or regulated by DFPS.
(d) Provides that Chapter 551 (Open Meetings), Government Code, applies to
the FPS council.
(e) Provides that Chapter 2110 (State Agency Advisory Committees),
Government Code, does not apply to the FPS council. Deletes requirement
for the board to be appointed without regard to race, color, disability,
sex, religion, age, or national origin.
(f) Provides that a majority of the members of the FPS council constitute
a quorum for the transaction of business.
Sec. 40.022. New heading: APPOINTMENTS. (a) and (b) Applies standard Sunset
language regarding appointments to the FPS council. Deletes existing
language making persons ineligible for appointment under certain
conditions.
Sec. 40.0226. New heading: TRAINING PROGRAM FOR COUNCIL MEMBERS.
Applies standard Sunset language regarding a training program for FPS
council members.
Sec. 40.024. New heading: TERMS; VACANCY. (a) Provides that members of the
FPS council, rather than board, serve for staggered six-year terms, with
the terms of three
members, rather than two members, expiring February 1 of each odd-numbered
year.
(b) Prohibits a member of the FPS council from serving more than two
consecutive full terms as a member.
(c) Requires the governor by appointment to fill the unexpired term of a
vacancy
on the FPS council.
Sec. 40.025. New heading: REIMBURSEMENT FOR EXPENSES. Applies standard
Sunset language regarding reimbursement for expenses of FPS council
members.
Sec. 40.026. New heading: PRESIDING OFFICER; OTHER OFFICERS. Applies
standard Sunset language regarding the presiding officer, officer, and
other officers.
Sec. 40.027. New heading: COMMISSIONER. (a) Requires the executive
commissioner of health and human services, to appoint a Department of
Family and Protective Services commissioner (DFPS commissioner), who is to
be selected according to education, training, experience, and demonstrated
ability.
(b) Provides that the DFPS commissioner serves at the pleasure of the
executive commissioner of health and human services.
(c) Requires the DFPS commissioner, subject to the control of the
executive commissioner of health and human services, to act as the DFPS's
chief administrative officer and as a liaison between DFPS and HHSC.
(d) Requires the DFPS commissioner to administer this chapter and other
laws
relating to DFPS under operational policies established by the executive
commissioner of health and human services and in accordance with the
memorandum of understanding under Section 531.0055(k), Government Code,
between the DFPS commissioner and the executive commissioner of health and
human services, as adopted by rule.
SECTION 1.13. Amends Title 7, Human Resources Code, by adding Chapter 117,
as follows:
CHAPTER 117. DEPARTMENT OF ASSISTIVE AND REHABILITATIVE SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 117.001. DEFINITIONS. Defines "commission," "commissioner,"
"council," "department," and "executive commissioner."
Sec. 117.002. AGENCY. Provides that the Department of Assistive and
Rehabilitative Services (DARS) is an agency of the state.
Sec. 117.003. SUNSET PROVISION. Applies standard Sunset language to
continue DARS until September 1, 2009.
[Reserves Sections 117.004-117.020 for expansion.]
SUBCHAPTER B. ADMINISTRATIVE PROVISIONS
Sec. 117.021. ASSISTIVE AND REHABILITATIVE SERVICES COUNCIL. (a) Provides
that the Assistive and Rehabilitative Services Council (ARS council) is
created to assist the executive commissioner of health and human services
in developing rules and policies for DARS.
(b) and (c) Applies standard Sunset language regarding the composition of
the ARS council and the eligibility of ARS council members.
(d) Provides that Chapter 551, Government Code, applies to the ARS
council.
(e) Provides that Chapter 2110, Government Code, does not apply to the ARS
council.
(f) Provides that a majority of the members of the ARS council constitute
a quorum for the transaction of business.
Sec. 117.022. APPOINTMENTS. Updates standard Sunset language relating to
appointments to the ARS council.
Sec. 117.023. TRAINING PROGRAM FOR COUNCIL MEMBERS. Updates standard
Sunset language relating to a training program for ARS council members.
Sec. 117.024. TERMS. Sets forth the terms of ARS council members.
Sec. 117.025. VACANCY. Requires the governor by appointment to fill the
unexpired
term of a vacancy on the ARS council.
Sec. 117.026. PRESIDING OFFICER; OTHER OFFICERS; MEETINGS. Applies
standard Sunset language regarding the presiding officer, other officers,
and
meetings.
Sec. 117.027. REIMBURSEMENT FOR EXPENSES. Applies standard Sunset
language relating to a reimbursement for expenses to an ARS council member.
Sec. 117.028. PUBLIC INTEREST INFORMATION AND COMPLAINTS. Updates
standard Sunset language requiring information to be maintained on
complaints.
Sec. 117.029. PUBLIC ACCESS AND TESTIMONY. Updates standard Sunset
language providing for public testimony at meetings under the jurisdiction
of DARS.
Sec. 117.030. POLICYMAKING AND MANAGEMENT RESPONSIBILITIES.
Updates standard Sunset language regarding the delineation of policymaking
and
management responsibilities.
Sec. 117.031. ANNUAL REPORT. (a) Requires the commissioner of assistive
and rehabilitative services to file annually with the governor, the
presiding officer of each house of the legislature, and the executive
commissioner of health and human services a complete and detailed written
report accounting for all funds received and disbursed by DARS during the
preceding fiscal year.
(b) Requires the annual report to be in the form and be reported in the
time
provided by the General Appropriations Act.
Sec. 117.032. OFFICES. Requires DARS to maintain its central office in
Austin. Authorizes DARS to maintain offices in other areas of the state as
necessary.
[Reserves Sections 117.033-117.050 for expansion.]
SUBCHAPTER C. PERSONNEL
Sec. 117.051. COMMISSIONER. (a) Requires the executive commissioner of
health and human services to appoint with the approval of the governor a
commissioner of the Department of Assistive and Rehabilitative Services
(ARS commissioner). Provides that the ARS commissioner is to be selected
according to education, training, experience, and demonstrated ability.
(b) Provides that the ARS commissioner serves at the pleasure of the
executive commissioner of health and human services.
(c) Requires the ARS commissioner, subject to the control of the executive
commissioner of health and human services, to act as DARS's chief
administrative officer and as a liaison between DARS and HHSC.
(d) Requires the ARS commissioner to administer this chapter under
operational
policies established by the executive commissioner of health and human
services and in accordance with the memorandum of understanding under
Section 531.0055(k), Government Code, between the ARS commissioner and the
executive commissioner of health and human services, as adopted by rule.
Sec. 117.052. PERSONNEL. (a) Authorizes DARS to employ, compensate,
and prescribe the duties of personnel necessary and suitable to administer
this chapter.
(b) Requires the executive commissioner of health and human services to
prepare and by rule to adopt personnel standards.
(c) Authorizes a personnel position to be filled only by an individual
selected and
appointed on a nonpartisan merit basis.
(d) Requires the executive commissioner of health and human services, with
the advice of the ARS council, to develop and DARS to implement policies
that clearly define the responsibilities of the staff of DARS.
Sec. 117.053. INFORMATION ABOUT QUALIFICATIONS AND STANDARDS OF
CONDUCT. Applies standard Sunset language regarding information about
qualifications and standards of conduct.
Sec. 117.054. MERIT PAY. Applies standard Sunset language regarding merit
pay.
Sec. 117.055. CAREER LADDER. Applies standard Sunset language regarding a
career
ladder.
Sec. 117.056. EQUAL EMPLOYMENT OPPORTUNITY POLICY. Updates standard
Sunset language regarding an equal employment opportunity program.
Sec. 117.057. STATE EMPLOYEE INCENTIVE PROGRAM. Applies standard Sunset
language regarding a state employee incentive program.
[Reserves Sections 117.058-117.070 for expansion.]
SUBCHAPTER D. POWERS AND DUTIES OF DEPARTMENT
Sec. 117.071. GENERAL POWERS AND DUTIES OF DEPARTMENT. Provides that
DARS is responsible for administering human services programs to provide
early childhood intervention services and rehabilitation and related
services to persons with disabilities other than developmental delay or
mental retardation and to persons who are blind, deaf, or hard of hearing.
Sec. 117.072. INFORMATION REGARDING COMPLAINTS. Updates standard
language requiring information to be maintained on complaints.
Sec. 117.073. RULES. Authorizes the executive commissioner of health and
human services to adopt rules reasonably necessary for DARS to administer
this chapter, consistent with the memorandum of understanding under
Section 531.0055(k), Government Code, between the ARS commissioner and the
executive commissioner of health and human services, as adopted by rule.
SECTION 1.13A. Amends the Human Resources Code by adding Title 11, as
follows:
TITLE 11. COMMUNITY-BASED AND LONG-TERM CARE SERVICES
CHAPTER 161. DEPARTMENT OF AGING AND DISABILITY SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 161.001. DEFINITIONS. Defines "commission," "commissioner,"
"council," "department," and "executive commissioner."
Sec. 161.002. AGENCY. Provides that the Department of Aging and Disability
Services
(DADS) is an agency of the state.
Sec. 161.003. SUNSET PROVISION. Applies standard Sunset language to
continue DADS until September 1, 2009.
[Reserves Sections 161.004-161.020 for expansion.]
SUBCHAPTER B. ADMINISTRATIVE PROVISIONS
Sec. 161.021. AGING AND DISABILITY SERVICES COUNCIL. (a) Provides that the
Aging and Disability Services Council (ADS council) is created to assist
the executive commissioner of health and human services in developing
rules and policies for DADS.
(b) and (c) Applies standard Sunset language regarding the composition of
and
eligibility of ADS council members.
(d) Provides that Chapter 551, Government Code, applies to the ADS council.
(e) Provides that Chapter 2110, Government Code, does not apply to the ADS
council.
(f) Provides that a majority of the members of the ADS council constitute
a quorum for the transaction of business.
Sec. 161.022. APPOINTMENTS. Updates standard Sunset language relating to
appointments to the ADS council.
Sec. 161.023. TRAINING PROGRAM FOR COUNCIL MEMBERS. Updates standard
Sunset language relating to a training program for ADS council members.
Sec. 161.024. TERMS. Sets forth the terms of ADS council members.
Sec. 161.025. VACANCY. Requires the governor by appointment to fill the
unexpired
term of a vacancy on the ADS council.
Sec. 161.026. PRESIDING OFFICER; OTHER OFFICERS; MEETINGS. (a) - (c)
Apply standard Sunset language regarding the presiding officer, other
officers, and
meetings.
Sec. 161.027. REIMBURSEMENT FOR EXPENSES. Applies standard Sunset
language relating to a reimbursement for expenses to an ADS council member.
Sec. 161.028. PUBLIC INTEREST INFORMATION AND COMPLAINTS. Updates
standard Sunset language requiring information to be maintained on
complaints.
Sec. 161.029. PUBLIC ACCESS AND TESTIMONY. Updates standard Sunset
language providing for public testimony at meetings under the jurisdiction
of DADS.
Sec. 161.030. POLICYMAKING AND MANAGEMENT RESPONSIBILITIES.
Updates standard Sunset language regarding the delineation of policymaking
and
management responsibilities.
Sec. 161.031. ANNUAL REPORT. (a) Requires the commissioner of aging and
disability
services to file annually with the governor, the presiding officer of
each house of the legislature, and the executive commissioner of health
and human services a complete and detailed written report accounting for
all funds received and disbursed by DADS during the preceding fiscal year.
(b) Requires the annual report to be in the form and be reported in the
time
provided by the General Appropriations Act.
Sec. 161.032. OFFICES. Requires DADS to maintain its central office in
Austin. Authorizes DADS to maintain offices in other areas of the state as
necessary.
[Reserves Sections 161.033-161.050 for expansion.]
SUBCHAPTER C. PERSONNEL
Sec. 161.051. COMMISSIONER. (a) Requires the executive commissioner of
health and human services to appoint with the approval of the governor a
commissioner of the Department of Aging and Disability Services (ADS
commissioner). Provides that the ADS commissioner is to be selected
according to education, training, experience, and demonstrated ability.
(b) Provides that the ADS commissioner serves at the pleasure of the
executive commissioner of health and human services.
(c) Requires the ADS commissioner, subject to the control of the executive
commissioner of health and human services, to act as DADS's chief
administrative officer and as a liaison between DADS and HHSC.
(d) Requires the ADS commissioner to administer this chapter under
operational
policies established by the executive commissioner of health and human
services and in accordance with the memorandum of understanding under
Section 531.0055(k), Government Code, between the ADS commissioner and the
executive commissioner of health and human services, as adopted by rule.
Sec. 161.052. PERSONNEL. (a) Authorizes DADS to employ, compensate,
and prescribe the duties of personnel necessary and suitable to administer
this chapter.
(b) Requires the executive commissioner of health and human services to
prepare and by rule adopt personnel standards.
(c) Authorizes a personnel position to be filled only by an individual
selected and
appointed on a nonpartisan merit basis.
(d) Requires the executive commissioner of health and human services, with
the advice of the ADS council, to develop and the department to implement
policies that clearly define the responsibilities of the staff of the
department.
Sec. 161.053. INFORMATION ABOUT QUALIFICATIONS AND STANDARDS OF
CONDUCT. Applies standard Sunset language regarding information about
qualifications and standards of conduct.
Sec. 161.054. MERIT PAY. Applies standard Sunset language regarding merit
pay.
Sec. 161.055. CAREER LADDER. Applies standard Sunset language regarding a
career
ladder.
Sec. 161.056. EQUAL EMPLOYMENT OPPORTUNITY POLICY. Updates standard
Sunset language requiring the executive commissioner of health and human
services to develop an equal employment opportunity program.
Sec. 161.057. STATE EMPLOYEE INCENTIVE PROGRAM. Applies standard Sunset
language regarding a state employee incentive program.
[Reserves Sections 161.058-161.070 for expansion.]
SUBCHAPTER D. POWERS AND DUTIES OF DEPARTMENT
Sec. 161.071. GENERAL POWERS AND DUTIES OF DEPARTMENT. Provides that
DADS is responsible for administering human services programs for the
aging
and disabled, including certain services.
Sec. 161.072. INFORMATION REGARDING COMPLAINTS. Updates standard Sunset
language requiring information to be maintained on complaints.
Sec. 161.073. RULES. Authorizes the executive commissioner of health and
human services to adopt rules reasonably necessary for DADS to administer
this chapter, consistent with the memorandum of understanding under
Section 531.0055(k), Government Code, between the ADS commissioner and the
executive commissioner of health and human services, as adopted by rule.
SECTION 1.14. APPOINTMENT OF COMMISSIONERS. (a) Requires the executive
commissioner of health and human services, as soon as possible, to appoint
the commissioner of state health services, the commissioner of family and
protective services, the commissioner of assistive and rehabilitative
services, and the commissioner of aging and disability services.
(b) Requires the executive commissioner of health and human services to
make the appointments of the commissioners required by this section so
that the ethnic diversity of this state is reflected in those
appointments.
SECTION 1.15. APPOINTMENTS OF COUNCIL MEMBERS. (a) Requires the governor,
as
soon as possible, to appoint the members of the State Health Services
Council in accordance with
Chapter 1001, Health and Safety Code, as added by this article. Provides
that in making the
initial appointments, the governor must designate three members for terms
expiring February 1,
2005, three members for terms expiring February 1, 2007, and three members
for terms expiring
February 1, 2009.
(b) Requires the governor, as soon as possible, to appoint the members of
the Family and Protective Services Council in accordance with Chapter 40,
Human Resources Code, as amended by this article. Provides that in making
the initial appointments, the governor must designate three members for
terms expiring February 1, 2005, three members for terms expiring February
1, 2007, and three members for terms expiring February 1, 2009.
(c) Requires the governor, as soon as possible, to appoint the members of
the Assistive and Rehabilitative Services Council in accordance with
Chapter 117, Human Resources Code, as added by this article. Provides that
in making the initial appointments, the governor must designate three
members for terms expiring February 1, 2005, three members for terms
expiring February 1, 2007, and three members for terms expiring February
1, 2009.
(d) Requires the governor, as soon as possible, to appoint the members of
the Aging and Disability Services Council in accordance with Chapter 161,
Human Resources Code, as added by this article. Provides that in making
the initial appointments, the governor must designate three members for
terms expiring February 1, 2005, three members for terms expiring February
1, 2007, and three members for terms expiring February 1, 2009.
(e) Requires the governor to appoint the members of the Health and Human
Services
Council in accordance with Chapter 531, Government Code, as amended by
this article.
Provides that in making the initial appointments, the governor must
designate three
members for terms expiring February 1, 2005, three members for terms
expiring February
1, 2007, and three members for terms expiring February 1, 2009.
SECTION 1.16. LIMITATION ON ACTIVITIES. Authorizes a state agency created
under this
article to perform, before the date specified in the transition plan
required under Section 1.23 of
this article, only those powers, duties, functions, programs, and
activities that relate to preparing
for the transfer of powers, duties, functions, programs, and activities to
that agency in accordance
with this article. Prohibits a state agency created under this article
from operating all or any part
of a health and human services program before the date specified in the
transition plan required
under Section 1.23 of this article.
SECTION 1.17. INITIAL COUNCIL MEETINGS. Requires the presiding officer of
the council
for each state agency created under this article to call the initial
meeting of the applicable council as soon as possible after the council
members are appointed.
SECTION 1.18. TRANSFERS TO THE HEALTH AND HUMAN SERVICES COMMISSION.
(a) Provides that on the date specified in the transition plan required
under Section 1.23 of this Article, certain powers, duties, functions,
programs, and activities are transferred to HHSC.
(b) Provides that on the date specified by Subsection (a) of this section
all obligations and contracts of, all property and records in the custody
of a state agency or entity, and all complaints, investigations, or
contested cases that are pending before a state agency or entity abolished
by Section 1.26 of this article or the governing body of the agency or
entity and that are related to a power, duty, function, program, or
activity transferred under Subsection (a) of this section are transferred
without change in status to HHSC.
(c) Provides that a rule or form adopted by a state agency or entity
abolished by Section 1.26 of this article that relates to a power, duty,
function, program, or activity transferred under Subsection (a) of this
section is a rule or form of HHSC and remains in effect until altered by
HHSC.
(d) Provides that a reference in law to a state agency or entity abolished
by Section 1.26 of this article, or to the governing body of the agency or
entity, that relates to a power, duty, function, program, or activity
transferred under Subsection (a) of this section means HHSC.
(e) Provides that a license, permit, or certification in effect that was
issued by a state agency or entity abolished by Section 1.26 of this
article and that relates to a power, duty, function, program, or activity
transferred under Subsection (a) of this section is continued in effect as
a license, permit, or certification of HHSC.
(f) Provides that all powers, duties, functions, programs, and activities
relating to audits,
including internal audits, transferred to HHSC under Subsection (a)(1) of
this section, and
all powers, duties, functions, programs, and activities relating to the
Texas Department of Human Services office of inspector general transferred
to HHSC under Subsection (a)(2)(D) of this section, are required to be
assumed by the HHSC's office of inspector
general. Provides that notwithstanding any other provision of law, a
reference in law to
the Texas Department of Human Services office of inspector general means
the HHSC's
office of inspector general.
SECTION 1.19. TRANSFERS TO THE DEPARTMENT OF STATE HEALTH SERVICES. (a)
Provides that on the date specified in the transition plan required under
Section 1.23 of this
article, certain powers, duties, functions, programs, and activities,
other than those related to
rulemaking, policymaking, or administrative support services such as
strategic planning and
evaluation, audit, legal, human resources, information resources,
accounting, purchasing,
financial management, and contract management services, are transferred to
the Department of
State Health Services.
(b) - (e) Make conforming changes relating to the transfers to the
Department of State Health Services.
SECTION 1.20. TRANSFERS TO THE DEPARTMENT OF FAMILY AND PROTECTIVE
SERVICES. (a) On the date specified in the transition plan required under
Section 1.23 of this article, certain powers, duties, functions, programs,
and activities, other than those related to rulemaking or policymaking or
administrative support services such as strategic planning and evaluation,
audit, legal, human resources, information resources, accounting,
purchasing, financial management, and contract management services, are
transferred to the Department of Family and Protective Services.
(b) - (e) Make conforming changes relating to the transfers to the
Department of Family and Protective Services.
SECTION 1.21. TRANSFERS TO THE DEPARTMENT OF AGING AND DISABILITY
SERVICES. (a) Provides that on the date specified in the transition plan
required under Section 1.23 of this article, certain powers, duties,
functions, programs, and activities, other than those related to
rulemaking or policymaking or administrative support services such as
strategic planning and evaluation, audit, legal, human resources,
information resources, accounting, purchasing, financial management, and
contract management services, are transferred to the Department of Aging
and Disability Services.
(b) - (e) Make conforming changes relating to the transfers to the
Department of
Aging and Disability Services.
SECTION 1.21A. TRANSFERS TO THE DEPARTMENT OF ASSISTIVE AND REHABILITATIVE
SERVICES. (a) Provides that on the date specified in the transition plan
required under Section 1.23 of this article, certain powers, duties,
functions, programs, and activities, other than those related to
rulemaking or policymaking or administrative support services such as
strategic planning and evaluation, audit, legal, human resources,
information resources, accounting, purchasing, financial management, and
contract management services, are transferred to the Department of
Assistive and Rehabilitative Services.
(b) - (e) Make conforming changes relating to the transfers to the
Department of
Assistive and Rehabilitative Services.
SECTION 1.22. FACILITATION OF TRANSFERS BY HEALTH AND HUMAN SERVICES
TRANSITION COUNCIL. (a) Provides that the Health and Human Services
Transition Council
(HHS transition council) is created to facilitate the transfer of powers,
duties, functions, programs, and activities among the state's health and
human services agencies and HHSC as provided by this article with a
minimal negative effect on the delivery of those services in this state.
(b) Provides that the HHS transition council is composed of 10 certain
members.
(c) Provides that the executive commissioner of health and human services
serves as presiding officer. Requires the members of the HHS transition
council to elect any other necessary officers.
(d) Requires the HHS transition council to meet at the call of the
presiding officer.
(e) Provides that a member of the HHS transition council serves at the
will of the appointing official.
(f) Prohibits a member of the HHS transition council from receiving
compensation for serving on the HHS transition council but entitles the
member to reimbursement for travel expenses incurred by the member while
conducting the business of the HHS transition council as provided by the
General Appropriations Act.
(g) Requires the HHS transition council, with assistance from HHSC and the
health and human services agencies, to advise the executive commissioner
of health and human services concerning certain matters.
(h) Requires the HHS transition council to fully consider all written and
oral submissions made on any matter or issue under the HHS transition
council's jurisdiction.
(i) Provides that Chapter 551, Government Code, applies to the HHS
transition council.
(j) Provides that the HHS transition council is abolished December 31,
2004.
SECTION 1.23. TRANSITION PLAN. (a) Provides that the transfer of powers,
duties,
functions, programs, and activities under Sections 1.18, 1.19, 1.20, 1.21,
and 1.21A of this article to HHSC, the Department of State Health
Services, the Department of Family and Protective Services, the Department
of Aging and Disability Services, and the Department of Assistive and
Rehabilitative Services, respectively, must be accomplished in accordance
with a
schedule included in a transition plan developed by the executive
commissioner of health and human services and submitted to the governor
and the Legislative Budget Board (LBB) not later than December 1, 2003.
Requires the executive commissioner of health and human services to
provide to the governor and the LBB transition plan status reports and
updates on at least a quarterly basis following submission of the initial
transition plan. Requires the transition plan to be made available to the
public.
(b) Requires HHSC not later than November 1, 2003, to hold a public
hearing and accept
public comment regarding the transition plan required to be developed by
the executive
commissioner of health and human services under Subsection (a) of this
section.
(c) Requires the executive commissioner of health and human services in
developing the transition plan, to hold public hearings in various
geographic areas in this state before submitting the plan to the governor
and the LBB as required by this section.
SECTION 1.24. APPLICABILITY OF FORMER LAW. Provides that an action brought
or
proceeding commenced before the date of a transfer prescribed by this
article in accordance with
the transition plan required under Section 1.23 of this article, including
a contested case or a
remand of an action or proceeding by a reviewing court, is governed by the
laws and rules
applicable to the action or proceeding before the transfer.
SECTION 1.25. WORK PLAN FOR HEALTH AND HUMAN SERVICES AGENCIES. (a)
Requires HHSC, the Department of Family and Protective Services, and each
health and human services agency created under this article to implement
the powers, duties, functions, programs, and activities assigned to the
agency under this article in accordance with a work plan designed by HHSC
to ensure that the transfer and provision of health and human services in
this state are
accomplished in a careful and deliberative manner.
(b) Requires a work plan designed by HHSC under this section to include
certain phases.
SECTION 1.26. ABOLITION OF STATE AGENCIES AND ENTITIES. (a) Provides for
the
abolition of certain state agencies and entities on the date on which
their respective powers,
duties, functions, programs, and activities are transferred under this
article.
(b) Provides that the abolition of a state agency or entity listed in
Subsection (a) of this
section and the transfer of its powers, duties, functions, programs,
activities, obligations,
rights, contracts, records, property, funds, and employees as provided by
this article do
not affect or impair an act done, any obligation, right, order, permit,
certificate, rule,
criterion, standard, or requirement existing, or any penalty accrued under
former law, and
that law remains in effect for any action concerning those matters.
SECTION 1.27. Provides that a reference in law to the Department of
Protective and Regulatory
Services means the Department of Family and Protective Services.
SECTION 1.28. REPEAL. Repealer:
(1) Sections 531.0057 (Authority Over Rulemaking at Health and Human
Services Agency), 531.034 (Review of Agency Rulemaking), and 531.0345
(Coordination on Inpatient Mental Health Issues; Commission
Review),Government Code;
(2) Sections 40.0225 (Restrictions on Board Members and Employees) and
40.023 (Removal from Board), Human Resources Code; and
(3) Article 2, Chapter 1505, Acts of the 76th Legislature, Regular
Session, 1999.
SECTION 1.29. EFFECTIVE DATE. (a) Effective date: September 1, 2003,
except as provided by Subsection (b) of this section.
(b) Provides that the Department of State Health Services, the Department
of Assistive and Rehabilitative Services, and the Department of Aging and
Disability Services are created on the date the executive commissioner
appoints the commissioner of the respective agency.
ARTICLE 2. ADMINISTRATION, OPERATION, AND FINANCING OF
HEALTH AND HUMAN SERVICES PROGRAMS AND PROVISION OF
HEALTH AND HUMAN SERVICES
SECTION 2.01. Amends Section 531.001, Government Code, by adding
Subdivision (1-a) to
define "child health plan program."
SECTION 2.02. (a) Amends Subchapter A, Chapter 531, Government Code, by
adding Section
531.017, as follows:
Sec. 531.017. PURCHASING DIVISION. (a) Requires HHSC to establish a
purchasing
division for the management of administrative activities related to the
purchasing
functions of HHSC and the health and human services agencies.
(b) Requires the purchasing division to seek to achieve targeted cost
reductions,
increase process efficiencies, improve technological support and customer
services, and enhance purchasing support for each health and human services
agency; and if cost-effective, contract with private entities to perform
purchasing
functions for HHSC and the health and human services agencies.
(b) Requires HHSC, not later than January 1, 2004, to develop and
implement a plan to
consolidate the purchasing functions of HHSC and health and human services
agencies in
a purchasing division under Section 531.017, Government Code, as added by
this section.
SECTION 2.03. Amends Section 531.021, Government Code, by adding
Subsections (c), (d), and (e), as follows:
(c) Requires HHSC in its adoption of reasonable rules and standards under
Subsection (b)(2) to include financial performance standards that, in the
event of a proposed rate reduction, provide private ICF-MR facilities and
home and community-based services providers with flexibility in
determining how to use 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) Authorizes HHSC in adopting rules and standards required by Subsection
(b)(2), to provide for payment of fees, charges, and rates in accordance
with certain formulas, procedures, or methodologies prescribed by HHSC's
rules; applicable state or federal law, policies, rules, regulations, or
guidelines; economic conditions that substantially and materially affect
provider participation in the Medicaid program, as determined by the
executive commissioner of health and human services; or available levels
of appropriated state and federal funds.
(e) Authorizes HHSC notwithstanding any other provision of Chapter 32,
Human Resources Code, Chapter 533, or this chapter, to 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).
SECTION 2.04. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.0335, as follows:
Sec. 531.0335. PROHIBITION ON PUNITIVE ACTION FOR FAILURE TO
IMMUNIZE. (a) Defines "person responsible for a child's care, custody, or
welfare" and
"punitive action."
(b) Requires the executive commissioner of health and human services by
rule to 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.
(c) Provides that this section does not affect a law, including Chapter
31, Human
Resources Code, that specifically provides a punitive action for failure
to ensure
that a child receives the immunization series prescribed by Section
161.004,
Health and Safety Code.
SECTION 2.05. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.0392, as follows:
Sec. 531.0392. RECOVERY OF CERTAIN THIRD-PARTY REIMBURSEMENTS
UNDER MEDICAID. (a) Defines "dually eligible individual."
(b) Requires HHSC to obtain Medicaid reimbursement from each fiscal
intermediary who makes a payment to a service provider on behalf of the
Medicare program, including a reimbursement for a payment made to a home
health services provider or nursing facility for services rendered to a
dually
eligible individual.
SECTION 2.06. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.063, as follows:
Sec. 531.063. CALL CENTER. (a) Requires HHSC, by rule, to establish a
call center
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.
(b) Requires HHSC to contract with at least one but not more than four
private
entities for the operation of a call center required by this section
unless HHSC
determines that contracting for the operation of the center would not be
costeffective.
(c) Requires each call center required by this section to be located in
this state. Provides that this subsection does not prohibit a call center
located in this state from processing overflow calls through a center
located in another state.
(d) Requires each call center required by this section to provide
translation services as required by federal law for clients unable to
speak, hear, or comprehend the English language.
(e) Requires HHSC to develop consumer service and performance standards for
the operation of a call center required by this section. Requires the
standards to
address a certain aspects of a call center.
(f) Requires HHSC to make available to the public the standards developed
under
Subsection (e).
(g) Requires HHSC to develop:
(1) mechanisms for measuring consumer service satisfaction; and
(2) performance measures to evaluate whether the call center meets the
standards developed under Subsection (e).
(h) Authorizes HHSC to inspect a call center and analyze its consumer
service
performance through use of a consumer service evaluator who poses as a
consumer of the call center.
(i) Requires the executive commissioner of health and human services,
notwithstanding Subsection (a), to 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. Requires
HHSC, in implementing the policies, to maintain sufficient offices in each
of HHSC's service areas to serve applicants for whom telephone,
electronic, or mail communication is a barrier to enrollment. Provides
that 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 2.07. (a) Amends Subchapter B, Chapter 531, Government Code, by
adding Section
531.065, as follows:
Sec. 531.065. CONSOLIDATION AND COORDINATION OF HEALTH INSURANCE
PREMIUM PAYMENT REIMBURSEMENT PROGRAMS. (a) Requires HHSC to
develop and implement a plan to consolidate and coordinate the
administration of the
health insurance premium payment reimbursement programs prescribed by
Section
62.059, Health and Safety Code, and Section 32.0422, Human Resources Code.
(b) Authorizes HHSC, if cost-effective, to contract with a private entity
to assist HHSC in developing and implementing a plan required by this
section.
(b) Repealer: Section 62.059(i) (relating to the Health Insurance Premium
Payment Reimbursement Program for Children Eligible for Child Health
Plan), Health and Safety Code, and Section 32.0422(m) (relating to the
Health Insurance Premium Payment Reimbursement Program for Medical
Assistance Recipients), Human Resources Code.
(c) Requires HHSC, not later than January 1, 2004, to develop and
implement a
plan to consolidate and coordinate the administration of health insurance
premium
payment reimbursement programs as required by Section 531.065, Government
Code, as added by this section.
SECTION 2.08. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.067, as follows:
Sec. 531.067. PUBLIC ASSISTANCE HEALTH BENEFIT REVIEW AND DESIGN
COMMITTEE. (a) Requires HHSC to appoint a Public Assistance Health Benefit
Review and Design Committee (committee). Provides that the committee
consists of nine representatives of health care providers participating in
the Medicaid program or the child health plan program, or both. Requires
the committee membership to include at least three representatives from
each program.
(b) Requires the executive commissioner of health and human services to
designate one member to serve as presiding officer for a term of two
years.
(c) Requires the committee to meet at the call of the presiding officer.
(d) Requires the committee to review and provide recommendations to HHSC
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 HHSC or a health and human services agency.
Requires the committee, in performing its duties under this subsection, to
review benefits provided under each of the programs and review procedures
for addressing high utilization of benefits by recipients.
(e) Requires HHSC to provide administrative support and resources as
necessary for the committee to perform its duties under this section.
(f) Provides that Section 2110.008 does not apply to the committee.
(g) Authorizes HHSC, in performing the duties under this section, to
design and
implement a program to improve and monitor clinical and functional
outcomes of a recipient of services under the state child health plan or
medical assistance program. Authorizes the program to use financial,
clinical, and other criteriabased on pharmacy, medical services, and other
claims data related to the child health plan or the state medical
assistance program. Requires HHSC to report to the committee on the fiscal
impact, including any savings associated with the strategies utilized
under this section.
SECTION 2.09. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.068, as follows:
Sec. 531.068. MEDICAID OR OTHER HEALTH BENEFIT COVERAGE. Provides
that 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 HHSC or a health and human services agency, HHSC
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 program by the Public Assistance Health
Benefit Review
and Design Committee established under Section 531.067.
SECTION 2.10. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.069, as follows:
Sec. 531.069. PERIODIC REVIEW OF VENDOR DRUG PROGRAM. (a) Requires
HHSC to periodically review all purchases made under the vendor drug
program to
determine the cost-effectiveness of including a component for prescription
drug benefits
in any capitation rate paid by the state under a Medicaid managed care
program or the
child health plan program.
(b) Requires HHSC, in making the determination required by Subsection (a),
to
consider the value of any prescription drug rebates received by the state.
SECTION 2.11. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.070, as follows:
Sec. 531.070. SUPPLEMENTAL REBATES. (a) Defines "labeler," "manufacturer,"
and
"wholesaler."
(b) Defines, for purposes of this section, "supplemental rebates."
(c) Authorizes HHSC to enter into a written agreement with a manufacturer
to
accept certain program benefits in lieu of supplemental rebates, as such
term is
defined herein, only if certain conditions exist.
(d) Provides that for the purposes of this section, a program benefit may
mean
disease management programs authorized under this title, drug product
donation
programs, drug utilization control programs, prescriber and beneficiary
counseling
and education, fraud and abuse initiatives, and other services or
administrative
investments with guaranteed savings to a program operated by a health and
human
services agency.
(e) Requires such program investments, other than as required to satisfy
the
provisions of this section, to be deemed an alternative to, and not the
equivalent
of, supplemental rebates and to be treated in the state's submissions to
the federal
government (including, as appropriate, waiver requests and quarterly
Medicaid
claims) so as to maximize the availability of federal matching payments.
(f) Provides that agreements by HHSC to accept program benefits as defined
by
this section: may not prohibit HHSC from entering into similar agreements
related
to different drug classes with other entities; shall be limited to a time
period
expressly determined by HHSC; and may only cover products that have
received
approval by the Federal Drug Administration at the time of the agreement,
and
new products approved after the agreement may be incorporated only under an
amendment to the agreement.
(g) Authorizes HHSC, for the purposes of this section, to consider a
monetary
contribution or donation to the arrangements described in Subsection (c)
for the
purpose of offsetting expenditures to other state health care programs,
but which
funding shall not be used to offset expenditures for covered outpatient
drugs as
defined by 42 U.S.C. Section 1396r-8(k)(2) under the vendor drug program.
Prohibits an arrangement under this subsection from yielding less than
the amount
the state would have benefitted under a supplemental rebate. Authorizes
HHSC to
consider an arrangement under this section as satisfying the requirements
related
to Section 531.072(b).
(h) Requires HHSC, subject to Subsection (i), to negotiate with
manufacturers
and labelers, including generic manufacturers and labelers, to obtain
supplemental
rebates for prescription drugs sold in this state under certain programs.
(i) Authorizes HHSC to by contract authorize a private entity to negotiate
with
manufacturers and labelers on behalf of HHSC.
(j) Authorizes a manufacturer or labeler that sells prescription drugs in
this state
to voluntarily negotiate with HHSC and enter into an agreement to provide
supplemental rebates for prescription drugs provided under certain
programs.
(k) Requires HHSC, in negotiating terms for a supplemental rebate amount,
to
consider certain factors.
(l) Requires HHSC to provide a written report to the legislature and the
governor
each year. Requires the report to contain certain information.
(m) Requires HHSC in negotiating terms for a supplemental rebate, to
utilize the
average manufacturer price (AMP), as defined in Section 1396r-8(k)(1) of
the
Omnibus Budget Reconciliation Act of 1990, as the cost basis for the
product.
(b) Requires HHSC, not later than January 1, 2004, to implement Section
531.070, Government Code, as added by this section.
SECTION 2.12. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.071, as follows:
Sec. 531.071. CONFIDENTIALITY OF INFORMATION REGARDING DRUG
REBATES, PRICING, AND NEGOTIATIONS. (a) Provides that notwithstanding any
other state law, information obtained or maintained by HHSC regarding
prescription drug
rebate negotiations or a supplemental 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,
Government
Code.
(b) Provides that information that is confidential under Subsection (a)
includes
information described by Subsection (a) that is obtained or maintained by
HHSC
in connection with the Medicaid vendor drug program, the child health plan
program, the kidney health care program, the children with special health
care
needs program, or another state program administered by HHSC or another
health and human services agency.
(c) Provides that general information about the aggregate costs of
different
classes of drugs is not confidential under Subsection (a).
SECTION 2.13. (a) Amends Subchapter B, Chapter 531, Government Code, by
adding Section
531.072, as follows:
Sec. 531.072. PREFERRED DRUG LISTS. (a) Requires HHSC, in a manner that
complies with applicable state and federal law, to adopt preferred drug
lists for the Medicaid vendor drug program and for prescription drugs
purchased through the child health plan program. Authorizes HHSC to
adopt preferred drug lists for
community mental health centers and state mental health hospitals.
(b) Provides that the preferred drug lists may contain only drugs provided
by a
manufacturer or labeler that reaches an agreement with HHSC on supplemental
rebates under Section 531.070.
(c) Requires HHSC, in making a decision regarding the placement of a drug
on
each of the preferred drug lists, to consider certain factors.
(d) Requires HHSC to provide for the distribution of current copies of the
preferred drug lists to all appropriate health care providers in this
state by posting
the list on the Internet. Requires HHSC, in addition, to mail copies of
the lists to
any health care provider on request of that provider.
(e) Defines "labeler" and "manufacturer" for purposes of this subsection.
Requires HHSC to ensure that: a manufacturer or labeler may submit written
evidence supporting the inclusion of a drug on the preferred drug lists
before a supplemental agreement is reached with HHSC; and any drug that
has been approved or has had any of its particular uses approved by the
United States Food and Drug Administration under a priority review
classification will be reviewed by the Pharmaceutical and Therapeutics
Committee (PT committee) at the next regularly scheduled meeting of the PT
committee. Requires HHSC, on receiving notice from a manufacturer or
labeler of the availability of a new product, to the extent possible, to
schedule a review for the product at the next regularly scheduled meeting
of the PT committee.
(f) Authorizes a recipient of drug benefits under the Medicaid vendor drug
program to appeal a denial of prior authorization under Section 531.073 of
a
covered drug or covered dosage through the Medicaid fair hearing process.
(b) Requires HHSC, not later than March 1, 2004, to adopt the preferred
drug lists as required by Section 531.072, Government Code, as added by
this section.
SECTION 2.14. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.073, as follows:
Sec. 531.073. PRIOR AUTHORIZATION FOR CERTAIN PRESCRIPTION DRUGS.
(a) Requires HHSC, in its rules and standards governing the Medicaid
vendor drug
program and the child health plan program, to 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. Authorizes HHSC to require prior
authorization for the reimbursement of a drug provided through a community
mental health center or state mental health hospital if HHSC adopts
preferred drug lists under Section 531.072 that apply to those facilities
and the drug is not included in the appropriate list. Requires HHSC to
require that the prior authorization be obtained by the prescribing
physician.
(a-1) Requires HHSC to delay requiring a prior authorization for drugs
that are used to treat patients with life-threatening and chronic
illnesses and that require complex medical management strategies until
HHSC has completed a study evaluating the impact of a requirement of prior
authorization on recipients. Requires HHSC to report its findings from the
study to the 79th Legislature or a subsequent legislature of this state.
(b) Requires HHSC to establish procedures for the prior authorization
requirement under the Medicaid vendor drug program to ensure that the
requirements of 42 U.S.C. Section 1396r-8(d)(5) and its subsequent
amendments
are met. Specifically, requires the procedures to ensure that: a prior
authorization
requirement is not imposed for a drug before the drug has been considered
at a
meeting of the PT committee established under Section 531.074; there will
be a
response to a request for prior authorization by telephone or other
telecommunications device within 24 hours after receipt of a request for
prior authorization; and a 72-hour supply of the drug prescribed will be
provided in an emergency or if HHSC does not provide a response within the
time required by Subdivision (2).
(c) Requires HHSC to 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 HHSC for a person who becomes
eligible under the child health plan program, the Medicaid program, or
another state program administered by HHSC 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 HHSC has
expired, whichever
occurs first.
(d) Requires HHSC to implement procedures to ensure that a recipient under
the
child health plan program, the Medicaid program, or another state program
administered by HHSC or a person who becomes eligible under the child
health
plan program, the Medicaid program, or another state program administered
by
HHSC or a health and human services agency receives continuity of care in
relation to certain prescriptions identified by HHSC.
(e) Authorizes HHSC to by contract authorize a private entity to
administer the
prior authorization requirements imposed by this section on behalf of HHSC.
(f) Prohibits a private entity or a provider participating in the child
health plan program, the Medicaid program, or another state program
administered by HHSC or a health and human services agency from receiving
a direct or indirect inducement, bonus, or other financial incentive based
on the denial or administrative delay of a medically appropriate drug
therapy, decreased usage of a particular drug or class of drugs, or a
reduction in the number of recipients receiving drug therapy.
(g) Requires HHSC to ensure that the prior authorization requirements are
implemented in a manner that minimizes the cost to the state and any
administrative burden placed on providers.
SECTION 2.15. (a) Amends Subchapter B, Chapter 531, Government Code, by
adding Section
531.074, as follows:
Sec. 531.074. PHARMACEUTICAL AND THERAPEUTICS COMMITTEE. (a)
Provides that the PT committee is established for the purposes of
developing recommendations for preferred drug lists adopted by HHSC under
Section 531.072.
(b) Provides that the PT committee consists of certain members appointed
by the
governor.
(c) Requires the governor in making appointments to the PT committee under
Subsection (b), to ensure that the PT committee includes physicians and
pharmacists who meet certain requirements.
(d) Provides that a member of the PT committee is appointed for a two-year
term
and may serve more than one term.
(e) Requires the governor to appoint a physician to be the presiding
officer of the
PT committee. Provides that the presiding officer serves at the pleasure
of the governor.
(f) Requires the PT committee to meet at least monthly during the six-month
period following establishment of the PT committee to enable the PT
committee to
develop recommendations for the initial preferred drug lists. Requires the
PT
committee, after that period, to meet at least quarterly and at other
times at the call
of the presiding officer or a majority of the PT committee members.
(g) Prohibits a member of the PT committee from receiving compensation for
serving on the PT committee but entitles the member to reimbursement for
reasonable and necessary travel expenses incurred by the member while
conducting the business of the PT committee, as provided by the General
Appropriations Act.
(h) Requires the PT committee, in developing its recommendations for the
preferred drug lists, to consider the clinical efficacy, safety,
cost-effectiveness,
and any program benefit associated with a product.
(i) Requires HHSC to adopt rules governing the operation of the PT
committee,
including rules governing the procedures used by the PT committee for
providing
notice of a meeting and rules prohibiting the PT committee from discussing
confidential information described by Section 531.071 in a public meeting.
Requires the PT committee to comply with the rules adopted under this
subsection.
(j) Requires the PT committee, to the extent feasible, to review all drug
classes
included in the preferred drug lists adopted under Section 531.072 at
least once
every 12 months and authorizes the PT committee to recommend inclusions to
and
exclusions from the list to ensure that the list provides for
cost-effective medically
appropriate drug therapies for Medicaid recipients and children receiving
health
benefits coverage under the child health plan program, and any other
affected individuals.
(k) Requires HHSC to provide administrative support and resources as
necessary
for the PT committee to perform its duties.
(l) Provides that Chapter 2110 does not apply to the committee.
(b) Requires the governor, not later than November 1, 2003, to appoint
members to the PT committee established under Section 531.074, Government
Code, as added by this section.
(c) Requires the PT committee established under Section 531.074,
Government Code, as added by this section, not later than January 1, 2004,
to submit recommendations for the preferred drug lists the PT committee is
required to develop under that section to HHSC.
SECTION 2.16. Amends Subchapter B, Chapter 531, Government Code, by adding
Section
531.075, as follows:
Sec. 531.075. PRIOR AUTHORIZATION FOR HIGH-COST MEDICAL SERVICES.
Authorizes HHSC to evaluate and implement, as appropriate, procedures,
policies, and
methodologies to require prior authorization for high-cost medical
services and procedures and to contract with qualified service providers
or organizations to perform those functions. Requires any such program to
recognize any prohibitions in federal law on limits in the amount,
duration, or scope of medically necessary services for children on
Medicaid.
SECTION 2.17. (a) Amends Section 531.101, Government Code, as follows:
Sec. 531.101. AWARD FOR REPORTING MEDICAID FRAUD, ABUSE, OR
OVERCHARGES. (a) Authorizes HHSC to 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 the program if HHSC determines that the disclosure results
in the recovery
of an administrative penalty imposed under Section 32.039, Human Resources
Code.
Prohibits HHSC from granting an award to an individual in connection with
a report if
HHSC or the attorney general had independent knowledge of the activity
reported by the
individual. Deletes text regarding overcharge or in the termination of the
fraudulent
activity or abuse of funds.
(b) Prohibits the award from exceeding five percent of the amount of the
administrative penalty imposed under Section 32.039, Human Resources Code,
rather than requiring it to be equal to not less than 10 percent of the
savings to this state, that resulted from the individual's disclosure.
Requires HHSC, in determining the amount of the award, to consider how
important the disclosure is in ensuring the fiscal integrity of the
program. Authorizes HHSC to also consider whether the individual
participated in the fraud, abuse, or overcharge. Deletes existing text to
Subsections (c) and (d) and redesignates Subsection (e) as (c).
(b) Provides that Section 531.101, Government Code, as amended by this
section,
applies only to a report that occurs on or after the effective date of
this section. Provides
that a report that occurs before the effective date of this section is
governed by the law in
effect at the time of the report, and the former law is continued in
effect for that purpose.
SECTION 2.18. (a) Amends Section 531.102, Government Code, as follows:
Sec. 531.102. New heading: OFFICE OF INSPECTOR GENERAL. (a) Provides that
HHSC, through HHSC's office of inspector general (office) rather than
through
investigations and enforcement, is responsible for the investigation of
fraud and abuse in
the provision of health and human services and the enforcement of state
law relating to
the provision of those services. Authorizes HHSC to obtain any information
or
technology necessary to enable the office to meet its responsibilities
under this subchapter
or other law.
(a-1) Requires the governor to appoint an inspector general to serve as
director of
the office. Provides that the inspector general serves a one-year term
that expires
on February 1.
(b) Requires HHSC, in consultation with the inspector general, to set clear
objectives, priorities, and performance standards for the office that
emphasize:
coordinating investigative efforts to aggressively recover money;
allocating
resources to cases that have the strongest supportive evidence and the
greatest
potential for recovery of money; and maximizing opportunities for referral
of
cases to the office of the attorney general in accordance with Section
531.103.
(c) Requires HHSC to train office staff to enable the staff to pursue
priority
Medicaid and other health and human services rather than welfare fraud and
abuse
cases as necessary.
(d) Authorizes HHSC to require employees of health and human services
agencies to provide assistance to the office, rather than to HHSC, in
connection
with the office's, rather than HHSC's, duties relating to the
investigation of fraud
and abuse in the provision of health and human services. The office is
entitled to
access to any information maintained by a health and human services agency,
including internal records, relevant to the functions of the office.
(e) Requires HHSC, in consultation with the inspector general, by rule to
set
specific claims criteria that, when met, require the office to begin an
investigation.
(f)(1) Requires the office, if HHSC receives a complaint of Medicaid fraud
or
abuse from any source, to conduct an integrity review to determine whether
there
is sufficient basis to warrant a full investigation. Requires an integrity
review to
begin not later than the 30th day after the date HHSC receives a complaint
or has
reason to believe that fraud or abuse has occurred. Requires an integrity
review to
be completed not later than the 90th day after it began.
(2) Requires the office to take certain action, as appropriate, if the
findings of an integrity review give the office reason to believe that an
incident of fraud or abuse involving possible criminal conduct has
occurred in the Medicaid program, not later than the 30th day after the
completion of the integrity review under certain conditions.
(g)(1) Requires the office, whenever the office learns or has reason to
suspect that a provider's records are being withheld, concealed,
destroyed, fabricated, or in any way falsified, to immediately refer the
case to the state's Medicaid fraud control unit. Provides that such
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.
(2) Requires the office, in addition to other instances authorized under
state or federal law, to impose without prior notice a hold on payment of
claims for reimbursement submitted by a provider to compel production of
records or when requested by the state's Medicaid fraud control unit, as
applicable. Requires the office to notify the provider of the hold on
payment not later than the fifth working day after the date the payment
hold is imposed.
(3) Requires the office, on timely written request by a provider subject
to a hold on payment under Subdivision (2), other than a hold requested by
the state's Medicaid fraud control unit, to file a request with the State
Office of Administrative Hearings for an expedited administrative hearing
regarding the hold. Provides that the provider must request an expedited
hearing under this subdivision not later than the 10th day after the date
the provider receives notice from the office under Subdivision (2).
(4) Requires HHSC to adopt rules that allow a provider subject to a hold
on payment under Subdivision (2), other than a hold requested by the
state's Medicaid fraud control unit, to seek an informal resolution of the
issues identified by the office in the notice provided under that
subdivision. Provides that a provider must seek an informal resolution
under this subdivision not later than the deadline prescribed by
Subdivision (3), and that a provider's decision to seek an informal
resolution under this subdivision does not extend the time by which the
provider must request an expedited administrative hearing under
Subdivision (3). Requires a hearing initiated under Subdivision (3) to be
stayed at the office's request until the informal resolution process is
completed.
(5) Requires the office to, in consultation with the state's Medicaid fraud
control unit, establish guidelines under which holds on payment or
program exclusions: may permissively be imposed on a provider or
are required to automatically be imposed on a provider.
(h) Authorizes the office, in addition to performing functions and duties
otherwise provided by law, to take certain actions.
(i) Provides that notwithstanding any other provision of law, a reference
in law or
rule to HHSC's office of investigations and enforcement means the office of
inspector general established under this section.
(b) Requires the governor, as soon as possible after the effective date of
this section, to
appoint a person to serve as inspector general in accordance with Section
531.102,
Government Code, as amended by this section. Provides that the initial
term of the
person appointed in accordance with this subsection expires February 1,
2005.
SECTION 2.19. Amends Subchapter C, Chapter 531, Government Code, by adding
Section
531.1021 as follows:
Sec. 531.1021. SUBPOENAS. (a) Authorizes the office of inspector general
to request
that the executive commissioner of health and human services or the
executive commissioner's designee approve the issuance by the office of a
subpoena in connection with an investigation conducted by the office.
Authorizes the office, if the request is approved, to 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.
(b) Authorizes a subpoena to be served personally or by certified mail.
(c) Authorizes the office, if a person fails to comply with a subpoena,
acting
through the attorney general, to file suit to enforce the subpoena in a
district court
in this state.
(d) Requires the court, on finding that good cause exists for issuing the
subpoena,
to order the person to comply with the subpoena. Authorizes the court to
punish a
person who fails to obey the court order.
(e) Requires the office to pay a reasonable fee for photocopies subpoenaed
under
this section in an amount not to exceed the amount the office may charge
for
copies of its records.
(f) Provides that the reimbursement of the expenses of a witness whose
attendance is compelled under this section is governed by Section 2001.103.
(g) Provides that all information and materials subpoenaed or compiled by
the
office in connection with an investigation are confidential and not
subject to
disclosure under Chapter 552, and not subject to disclosure, discovery,
subpoena,
or other means of legal compulsion for their release to anyone other than
the
office or its employees or agents involved in the investigation conducted
by the
office, except that this information may be disclosed to the office of the
attorney
general and law enforcement agencies.
SECTION 2.20. (a) Amends Section 531.103, Government Code, as follows:
Sec. 531.103. INTERAGENCY COORDINATION. (a) Requires HHSC, acting through
its office of inspector general, and the office of the attorney general to
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 other program administered by HHSC or a health and human
services agency,
including the financial assistance program under Chapter 31, Human
Resources Code, a
nutritional assistance program under Chapter 33, Human Resources Code, and
the child
health plan program. Requires the memorandum of understanding to require
certain
actions from certain entities.
(b) Provides that an exchange of information under this section between the
office of the attorney general and HHSC, the office of inspector general,
or a
health and human services agency does not affect whether the information is
subject to disclosure under Chapter 552. Makes conforming changes.
(c) Requires HHSC and the office of the attorney general to jointly
prepare and
submit a semiannual report to the governor, lieutenant governor, speaker
of the
house of representatives, and comptroller concerning the activities of
those
agencies in detecting and preventing fraud, waste, and abuse under the
state
Medicaid program or other program administered by HHSC or a health and
human services agency. Makes a conforming changes.
(d) No change to this subsection.
(e) Requires the memorandum of understanding required by this section, in
addition to the provisions required by Subsection (a), to also ensure that
no
barriers to direct fraud referrals to the office of the attorney general's
Medicaid
fraud control unit or unreasonable impediments to communication between
Medicaid agency employees and the Medicaid fraud control unit are imposed,
and
to include procedures to facilitate the referral of cases directly to the
office of the
attorney general. Deletes existing text relating to requiring HHSC to
refer a case
of suspected fraud, waste, or abuse under the state Medicaid program to
certain
persons under certain conditions and the subsequent actions to be taken.
(f) Authorizes a district attorney, county attorney, city attorney, or
private
collection agency to collect and retain costs associated with a case
referred to the
attorney or agency in accordance with procedures adopted under this
section and
20 percent of the amount of the penalty, restitution, or other
reimbursement
payment collected.
(b) Requires the office of the attorney general and HHSC to amend the
memorandum of
understanding required by Section 531.103, Government Code, as necessary
to comply
with that section, as amended by this section, not later than December 1,
2003.
SECTION 2.21. Amends Section 531.104(b), Government Code, to require the
memorandum of
understanding to specify the type, scope, and format of the investigative
support provided to the
attorney general under this section. Deletes language stating that the
commission is not required
to provide investigative support in more than 100 open investigations in a
fiscal year.
SECTION 2.22. (a) Amends Subchapter C, Chapter 531, Government Code, by
adding Section
531.1063, as follows:
Sec. 531.1063. MEDICAID FRAUD PILOT PROGRAM. (a) Requires HHSC, with
cooperation from the Texas Department of Human Services (TDHS), to develop
and implement a front-end Medicaid fraud reduction pilot program in one or
more counties in this state to address provider fraud and appropriate
cases of third-party and recipient fraud.
(b) Requires the program to be designed to reduce the number of fraud cases
arising from authentication fraud and abuse; the total amount of Medicaid
expenditures; and the number of fraudulent participants.
(c) Requires the program to include: participant smart cards and biometric
readers that reside at the point of contact with Medicaid providers,
recipients,
participating pharmacies, hospitals, and appropriate third-party
participants; a
secure finger-imaging system that is HIPAA compliant and the use of any
existing
state database of fingerprint images developed in connection with the
financial
assistance program under Chapter 31, Human Resources Code, with fingerprint
images collected as part of the program to only be placed on the smart
card; and a
monitoring system.
(d) Authorizes HHSC, in implementing the program, to exempt recipients who
are children or who are elderly or disabled and obtain a fingerprint image
from a parent or caretaker of a recipient who is a child, regardless of
whether the parent or caretaker is a recipient.
(e) Requires HHSC to ensure that the procedures for obtaining fingerprint
images of participating recipients and parents and caretakers who are not
recipients are designed in a flexible manner that gives consideration to
transportation barriers and work schedules of those individuals.
(f) Requires the program and all associated hardware and software to easily
integrate into participant settings and be initially tested in a physician
environment
in this state and determined to be successful in authenticating recipients,
providers, and provider staff members before the program is implemented
throughout the program area, to ensure reliability.
(g) Authorizes HHSC to extend the program to additional counties if it
determines
that expansion would be cost-effective.
(b) Requires HHSC to begin implementation of the program required by
Section
531.1063, Government Code, as added by this section, not later than
January 1, 2004.
(c) Requires HHSC to report to certain persons regarding the program
required by
Section 531.1063, Government Code, as added by this section, not later
than February 1,
2005. Requires the report to include an identification and evaluation of
the benefits of
the program and recommendations regarding expanding the program statewide.
SECTION 2.23. Amends Section 531.107(b), Government Code, to include a
representative of
the Texas Department of Health (TDH), appointed by the commissioner of
public health, to the task force.
SECTION 2.24. (a) Amends Subchapter C, Chapter 531, Government Code, by
adding Section
531.113, as follows:
Sec. 531.113. MANAGED CARE ORGANIZATIONS: SPECIAL INVESTIGATIVE
UNITS OR CONTRACTS. (a) Requires each managed care organization that
provides
or arranges for the provision of health care services to an individual
under a governmentfunded program, including the Medicaid program and the
child health plan program, to
perform certain functions.
(b) Requires each managed care organization subject to this section to
adopt a
plan to prevent and reduce fraud and abuse and annually file that plan with
HHSC's office of inspector general for approval. Requires the plan to
include
certain information.
(c) Requires the managed care organization to file with HHSC's office
of inspector general certain information, if a managed care organization
contracts
for the investigation of fraudulent claims and other types of program
abuse by
recipients and service providers under Subsection (a)(2).
(d) Authorizes HHSC's office of inspector general to review the records of
a
managed care organization to determine compliance with this section.
(e) Requires the executive commissioner of health and human services to
adopt rules as necessary to accomplish the purposes of this section.
(b) Requires a managed care organization subject to Section 531.113,
Government Code,
as added by this section, to comply with the requirements of that section
not later than
September 1, 2004.
SECTION 2.25. (a) Amends Subchapter C, Chapter 531, Government Code, by
adding Section
531.114, as follows:
Sec. 531.114. FINANCIAL ASSISTANCE FRAUD. (a) Prohibits a person from
intentionally making a statement that the person knows is false or
misleading,
misrepresenting, concealing, or withholding a fact, or knowingly
misrepresenting a
statement as being true, for purposes of establishing or maintaining the
eligibility of a
person and the person's family for financial assistance under Chapter 31,
Human
Resources Code, or for purposes of increasing or preventing a reduction in
the amount of
that assistance.
(b) Requires HHSC to take certain actions, if after an investigation it
determines
that a person violated Subsection (a).
(c) Provides that if a person waives the right to a hearing or if a
hearing officer at
an administrative hearing held under this section determines that a person
violated
Subsection (a), the person is ineligible to receive financial assistance
as provided
by Subsection (d). Authorizes a person who a hearing officer determines
violated
Subsection (a) to appeal that determination by filing a petition in the
district court
in the county in which the violation occurred not later than the 30th day
after the
date the hearing officer made the determination.
(d) Provides that a person determined under Subsection (c) to have violated
Subsection (a) is not eligible for financial assistance: before the first
anniversary
of the date of that determination, if the person has no previous
violations; and
permanently, if the person was previously determined to have committed a
violation.
(e) Provides that if a person is convicted of a state or federal offense
for conduct
described by Subsection (a), or if the person is granted deferred
adjudication or
placed on community supervision for that conduct, the person is permanently
disqualified from receiving financial assistance.
(f) Provides that this section does not affect the eligibility for
financial assistance
of any other member of the household of a person ineligible as a result of
Subsection (d) or (e).
(g) Requires HHSC to adopt rules as necessary to implement this section.
(b) Makes application of Section 531.114, Government Code, as added by
this section, prospective.
SECTION 2.26. Amends Subchapter C, Chapter 531, Government Code, by adding
Section
531.115, as follows:
Sec. 531.115. FEDERAL FELONY MATCH. Requires HHSC to develop and
implement a system to cross-reference data collected for the programs
listed under
Section 531.008(c) with the list of fugitive felons maintained by the
federal government.
SECTION 2.27. Amends Subchapter C, Chapter 531, Government Code, by adding
Section
531.116, as follows:
Sec. 531.116. COMPLIANCE WITH LAW PROHIBITING SOLICITATION. Provides
that a provider who furnishes services under the Medicaid program or 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 2.28. Amends Subchapter A, Chapter 533, Government Code, by adding
Section
533.0025, as follows:
Sec. 533.0025. DELIVERY OF SERVICES. (a) Provides that in this section,
"medical
assistance" has the meaning assigned by Section 32.003, Human Resources
Code.
(b) Requires HHSC, except as otherwise provided by this section and
notwithstanding any other law, to provide medical assistance for acute care
through the most cost-effective model of Medicaid managed care as
determined
by HHSC. Authorizes HHSC to provide medical assistance for acute care in a
certain part of this state or to a certain population of recipients using
certain health
care models, if HHSC determines that it is more cost-effective.
(c) Requires the executive commissioner of health and human services to
consider certaininformation in determining whether a model or arrangement
described by
Subsection (b) is more cost-effective.
(d) Requires HHSC, if it determines that it is not more cost-effective to
use a
Medicaid managed care model to provide certain types of medical assistance
for
acute care in a certain area or to certain medical assistance recipients
as prescribed
by this section, to provide medical assistance for acute care through a
traditional
fee-for-service arrangement.
SECTION 2.29. Amends Subchapter A, Chapter 533, Government Code, by adding
Section
533.0132, as follows:
Sec. 533.0132. STATE TAXES. Requires HHSC to ensure that any experience
rebate or
profit sharing for managed care organizations is calculated by treating
premium,
maintenance, and other taxes under the Insurance Code and any other taxes
payable to
this state as allowable expenses for purposes of determining the amount of
the experience
rebate or profit sharing.
SECTION 2.30. Amends Sections 403.105(a) and (c), Government Code, as
follows:
(a) Provides that the permanent fund for health and tobacco education and
enforcement, rather than the permanent fund for tobacco education and
enforcement, is a dedicated account in the general revenue fund.
(c) Includes the provision of coordinated essential public health services
administered by
TDH as a service for which available earnings of the fund may be
appropriated to TDH.
Makes conforming changes.
SECTION 2.31. Amends the heading to Section 403.105, Government Code, to
read as follows:
Sec. 403.105. PERMANENT FUND FOR HEALTH AND TOBACCO EDUCATION
AND ENFORCEMENT.
SECTION 2.32. Amends Section 403.1055(c), Government Code, to include
among the
purposes for which available earnings of the fund may be appropriated to
the Interagency Council on Early Childhood Intervention to provide
intervention services for children with developmental delay or who have a
high probability of developing developmental delay and the families of
those children.
SECTION 2.33. (a) Provides that effective September 1, 2003, Section
466.408(b), Government
Code, is amended to require that if a claim is not made for lottery prize
money on or before the
180th day after the date on which the winner was selected, the prize money
to be used, in order of priority, for: $20 million in prize money each
year to be deposited to the credit of the TDH's stateowned
multicategorical teaching hospital account, which is an account in the
general revenue fund; $5 million in prize money each year to be used by
HHSC to support the provision of inpatient hospital services in hospitals
located in the 15 counties that comprise the Texas-Mexico border area,
with payment for those services to be not less than the amount established
under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) cost
reimbursement methodology for the hospital providing the services; and all
remaining prize money subject to this section to be deposited in the
tertiary care facility account and may be appropriated only for purposes
specified in Chapter 46 or 61, Health and Safety Code. Deletes existing
text relating to deposit of such funds to the credit of the TDH
state-owned multicategorical teaching hospital account or the tertiary
care facility account.
(b) Effective September 1, 2005, Section 466.408(b), Government Code, is
reenacted as
follows:
(b) Requires the prize money to be deposited to the credit of the TDH
state-owned
multicategorical teaching hospital account or the tertiary care facility
account in a certain manner if a claim is not made for prize money on or
before
the 180th day after the date on which the winner was selected.
(c) Provides that it is the intent of the legislature that HHSC, to the
extent
possible, is required to take all action necessary to provide the highest
level of
possible financial support to providing community care services and
support for
the aging, as appropriate to reflect the legislature's priority for those
programs
reflected in the General Appropriations Act.
SECTION 2.34. Amends the heading to Subchapter C, Chapter 531, Government
Code, to read
as follows:
SUBCHAPTER C. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES
FRAUD, ABUSE, OR OVERCHARGES
SECTION 2.35. Amends Subchapter C, Chapter 531, Government Code, by adding
Section
531.1011, as follows:
Sec. 531.1011. DEFINITIONS. Defines "fraud," "hold on payment,"
"practitioner,"
"program exclusion," and "provider."
SECTION 2.36. (a) Amends Subchapter B, Chapter 12, Health and Safety
Code, by adding
Sections 12.0111 and 12.0112, as follows:
Sec. 12.0111. LICENSING FEES. (a) Provides that this section applies in
relation to
each licensing program administered by TDH or administered by a regulatory
board or other agency that is under the jurisdiction of TDH or
administratively attached to TDH. Provides that in this section and
Section 12.0112, "license" includes a permit, certificate, or
registration.
(b) Requires TDH to charge a fee for issuing or renewing a license that is
in an
amount designed to allow TDH to recover from its license holders all of
TDH's
direct and indirect costs in administering and enforcing the applicable
licensing
program, notwithstanding other law.
(c) Requires each regulatory board or other agency that is under the
jurisdiction
of TDH or administratively attached to TDH and that issues licenses to
charge a
fee for issuing or renewing a license that is in an amount designed to
allow TDH
and the regulatory board or agency to recover from the license holders all
of the
direct and indirect costs to TDH and to the regulatory board or agency in
administering and enforcing the applicable licensing program,
notwithstanding other law.
(d) Provides that this section does not apply to a person regulated under
Chapter 773.
Sec. 12.0112. TERM OF LICENSE. (a) Provides that, notwithstanding other
law and except as provided by Subsection (b), the term of each license
issued by TDH, or by a regulatory board or other agency that is under the
jurisdiction of TDH or administratively attached to TDH, is two years.
Authorizes TDH, the regulatory board, or agency to provide for staggering
the issuance and renewal of licenses.
(b) Provides that this section does not apply to a license issued for a
youth camp under Chapter 141.
(b) Provides that Section 12.0111, Health and Safety Code, as added by this
section, applies only to a license, permit, certificate, or registration
issued or
renewed by TDH, or by a regulatory board or other agency that is under the
jurisdiction of TDH or administratively attached to TDH, on or after
January 1,
2004.
(c) Provides that Section 12.0112, Health and Safety Code, as added by this
section, applies only to a license, permit, certificate, or registration
that is issued
or renewed on or after January 1, 2005.
SECTION 2.37. Amends Sections 62.055(a), (d), and (e), Health and Safety
Code, as follows:
(a) Deletes "another entity, including the Texas Healthy Kids Corporation
under
Subchapter F, Chapter 109, to obtain health benefit plan coverage for
children who are
eligible for coverage under the state child health plan" as an entity HHSC
is authorized to
contract with in administering the child health plan.
(d) and (e) Make conforming changes.
SECTION 2.38. (a) Amends Subchapter B, Chapter 62, Health and Safety Code,
by adding
Section 62.0582, as follows:
Sec. 62.0582. THIRD-PARTY BILLING VENDORS. (a) Prohibits a third-party
billing
vendor from submitting a claim with HHSC for payment on behalf of a health
plan
provider under the program unless the vendor has entered into a contract
with HHSC
authorizing that activity.
(b) Requires to the extent practical, that the contract contain provisions
comparable to the provisions contained in contracts between HHSC and
health plan providers, with an emphasis on provisions designed to prevent
fraud or abuse under the program. Requires, at a minimum, the contract to
require the third-party billing vendor to follow certain requirements.
(c) Requires HHSC to send a remittance notice directly to the provider
referenced
in the claim, on receipt of a claim submitted by a third-party billing
vendor.
Requires the notice to include detailed information regarding the claim
submitted
on behalf of the provider.
(d) Requires HHSC to take all action necessary, including any
modifications of
HHSC's claims processing system, to enable the commission to identify and
verify a third-party billing vendor submitting a claim for payment under
the
program, including identification and verification of any computer or
telephone
line used in submitting the claim, any relevant user password used in
submitting
the claim, and any provider number referenced in the claim.
(e) Requires HHSC to audit each third-party billing vendor subject to this
section
at least annually to prevent fraud and abuse under the program.
(b) Provides that Section 62.0582, Health and Safety Code, as added by
this section,
takes effect January 1, 2006.
SECTION 2.39. Amends Section 62.002(4), Health and Safety Code, to
redefine "net family
income."
SECTION 2.40. Amends Sections 62.101(b) and (c), Health and Safety Code,
as follows:
(b) Requires HHSC to 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 net family
income is at or
below 165, rather than 200, percent of the federal poverty level is
eligible for health
benefits coverage under the program, unless different income eligibility
levels are
prescribed by the General Appropriations Act.
(c) Requires the executive commissioner of health and human services to
take certain actions, in the event that appropriated money is insufficient
to sustain enrollment at the authorized eligibility level or enrollment
exceeds the number of children authorized to be enrolled in the child
health plan under the General Appropriations Act.
SECTION 2.41. Amends Section 62.1015(b), Health and Safety Code, to
provide that a child
enrolled in the child health plan under this section is subject to the
same requirements and
restrictions relating to income eligibility, continuous coverage, and
enrollment, including
applicable waiting periods, as any other child enrolled in the child
health plan.
SECTION 2.42. Amends Section 62.102, Health and Safety Code, as follows:
Sec. 62.102. CONTINUOUS COVERAGE. Requires HHSC to provide that an
individual who is determined to be eligible for coverage under the child
health plan
remains eligible for those benefits until the earlier of the end of a
period, not to exceed
180 days, rather than 12 months, following the date of the eligibility
determination or
the individual's 19th birthday.
SECTION 2.43. Amends Section 62.151, Health and Safety Code, by amending
Subsection (b)
and adding Subsections (e) and (f), as follows:
(b) Requires HHSC in developing the covered benefits to consider the
health care needs of healthy children and children with special health
care needs. Deletes language relating to required benefits under the
child health plan benefits package that are actuarially equivalent, as
determined in accordance with 3142 U.S.C. Section 1397cc, to the basic
plan for active state employees offered through health maintenance
organizations under the Texas Employees Uniform Group Insurance Benefits
Act (Article 3.50-2, Vernon's Texas 2 Insurance Code), as determined by
HHSC, and are at least the covered benefits described by the recommended
benefits package described for a state-designed child health plan by the
Texas House of Representatives Committee on Public Health "CHIP" Interim
Report to the Seventy-Sixth Texas Legislature dated December, 1998, and
the Senate Interim Committee on Children's Health Insurance Report to the
Seventy-Sixth Texas Legislature dated December 1, 1998.
(e) Requires HHSC, in developing the covered benefits, to seek input from
the Public
Assistance Health Benefit Review and Design Committee established under
Section
531.067, Government Code.
(f) Authorizes HHSC, if it determines the policy to be cost-effective, to
ensure that an
enrolled child does not, unless authorized by HHSC in consultation with
the child's
attending physician or advanced practice nurse, receive under the child
health plan more
than four different outpatient brand-name prescription drugs during a
month or
more than a 34-day supply of a brand-name prescription drug at any one
time.
SECTION 2.44. Amends Section 62.153, Health and Safety Code, by amending
Subsection (b)
and adding Subsection (d), as follows:
(b) Provides that subject to Subsection (d), cost-sharing provisions
adopted under this section shall ensure that families with higher levels
of income are required to pay progressively higher percentages of the cost
of the plan.
(d) Authorizes cost-sharing provisions adopted under this section to be
determined based
on the maximum level authorized under federal law.
SECTION 2.45. (a) Amends the heading to Section 62.154, Health and Safety
Code, to read as
follows:
Sec. 62.154. WAITING PERIOD; CROWD OUT.
(b) Amends Sections 62.154(a), (b), and (d), Health and Safety Code, as
follows:
(a) Makes a nonsubstantive change.
(b) Provides that a child is not subject to a waiting period adopted under
Subsection (a) if 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 HHSC. Makes conforming changes.
(d) Requires the waiting period required by Subsection (a) to extend for a
period
of 90 days after the first day of the month in which the applicant is
enrolled under the child health plan, rather than was covered under a
health benefits plan. Deletes language requiring that a child who was
covered by a health benefits plan at any time during the 90 days before
the date of application for coverage under the child health plan, other
than a child who was covered under a health benefits plan provided under
Chapter 109, be subject to the waiting period under Subsection (a).
SECTION 2.46. Amends Sections 62.155(c) and (d), Health and Safety Code,
as follows:
(c) Authorizes HHSC to give preference to a person who provides similar
coverage
under the Medicaid program in selecting a health plan provider and
requires HHSC to provide for a choice of at least, two health plan
providers in each service, rather than metropolitan area. Deletes a
reference to the Texas Healthy Kids Corporation.
(d) Makes conforming changes.
SECTION 2.47. Amends Subchapter D, Chapter 62, Health and Safety Code, by
adding Section
62.158, as follows:
Sec. 62.158. STATE TAXES. Requires HHSC to ensure that any experience
rebate or
profit-sharing for health plan providers under the child health plan is
calculated by
treating premium, maintenance, and other taxes under the Insurance Code
and any other
taxes payable to this state as allowable expenses for purposes of
determining the amount
of the experience rebate or profit-sharing.
SECTION 2.48. Amends Section 142.003(a), Health and Safety Code, to
include in the list of
persons that need not be licensed under this chapter a person who provides
services under a home
and community-based services waiver program for persons with mental
retardation adopted in
accordance with Section 1915(c) of the federal Social Security Act (42
U.S.C. Section 1396n), as
amended, and that is funded wholly or partly by the Texas Department of
Mental Health and Mental Retardation (MHMR) and monitored by MHMR or by a
designated local authority in accordance with standards adopted by MHMR.
SECTION 2.49. Amends Section 142.009(j), Health and Safety Code, to remove
Subsection (i)
as an exception.
SECTION 2.50. (a) Amends Section 242.047, Health and Safety Code, as
follows:
Sec. 242.047. New heading: ACCREDITATION REVIEW TO SATISFY INSPECTION
OR CERTIFICATION REQUIREMENTS. (a) Requires the Texas Department of Human
Services (DHS) to accept an annual accreditation review from the Joint
Commission on Accreditation of Health Organizations (JCAHO) for a nursing
home instead of an inspection for renewal of a license under Section
242.033 and in satisfaction of the requirements for certification by DHS
for participation in the medical assistance program under Chapter 32,
Human Resources Code, and the federal Medicare program, but only if
certain conditions apply, including that DHS has determined whether a
waiver or authorization from a federal agency is necessary under federal
law, including for federal funding purposes, before the department accepts
an annual accreditation review from JCAHO for certain purposes and
obtained any necessary federal waivers or authorizations.
(b) Requires DHS to coordinate its licensing and certification activities
with
JCAHO.
(c) Requires DHS and JCAHO to sign a memorandum of agreement to
implement this section. Requires the memorandum to provide that if all
parties to
the memorandum do not agree in the development, interpretation, and
implementation of the memorandum, any area of dispute is to be resolved by
the
Texas Board of Human Services.
(d) Provides that except as specifically provided by this section, this
section does
not limit DHS in performing any duties and inspections authorized by this
chapter or under any contract relating to the medical assistance program
under
Chapter 32, Human Resources Code, and Titles XVIII and XIX of the Social
Security Act (42 U.S.C. Sections 1395 et seq. and 1396 et seq.), including
authority to take appropriate action relating to an institution, such as
closing the
institution.
(e) Provides that this section does not require a nursing home to obtain
accreditation from JCAHO.
(b) Requires DHS, not later than October 1, 2003, to take certain actions.
(c) Requires DHS, not later than December 1, 2003, to report its progress
under
Subsection (b) of this section to the governor and to the presiding
officer of each house of
the legislature.
SECTION 2.51. (a) Amends Section 242.063(d), Health and Safety Code, to
require, rather than
authorize, a suit for a temporary restraining order or other injunctive
relief to be brought in the
county in which the alleged violation occurs. Deletes text relating to
Chapter 15, Civil Practice
and Remedies Code, or Section 65.023, Civil Practice and Remedies Code as
providing
exceptions to this subchapter. Deletes existing text relating to requiring
a suit for a temporary
restraining order or other injunctive relief to be brought in Travis
County.
(b) Repealer: Section 242.063(e) (Injunction), Health and Safety Code.
(c) Makes application of the changes in law made by this section to
Section 242.063(d),
Health and Safety Code, prospective.
SECTION 2.52. Amends Section 242.065(b), Health and Safety Code, to
require the trier of fact
to consider certain information, in determining the amount of a penalty to
be awarded under this
section. Deletes text requiring the trier of fact to consider the nature,
circumstances, extent, and gravity of the violation and the hazard or
potential hazard created by the violation to the health or safety of a
resident.
SECTION 2.53. (a) Amends Section 242.070, Health and Safety Code, as
follows:
Sec. 242.070. APPLICATION OF OTHER LAW. Prohibits DHS from assessing more
than one monetary penalty under this chapter and Chapter 32, Human
Resources Code,
for a violation arising out of the same act or failure to act, except as
provided by Section
242.0665(c). Authorizes DHS to assess the greater of a monetary penalty
under this
chapter or, rather than and, a monetary penalty under Chapter 32, Human
Resources
Code, for the same act or failure to act.
(b) Makes application of the change in law made by this section to Section
242.070, Health and Safety Code, prospective.
SECTION 2.54. Amends Section 242.601(a), Health and Safety Code, to
require an institution to
establish medication administration procedures. Deletes existing text
relating to establishing
medication administration procedures to ensure certain conditions are met.
SECTION 2.55. Amends Section 242.603(a), Health and Safety Code, to
require an institution
to store medications under appropriate conditions of sanitation,
temperature, light, moisture,
ventilation, segregation, and security. Deletes existing text relating to
storage locations, procedures, and security requirements for poisons,
medications used externally, and medications taken internally.
SECTION 2.56. (a) Amends Section 245.004(a), Health and Safety Code, to
provide that
the office of a physician licensed under Subtitle B, Title 3, Occupations
Code, need not be licensed under this chapter unless the office is used
for the purpose of performing more than 50, rather than 300, abortions in
any 12-month period.
(b) Requires an office of a physician required by Section 245.004(a),
Health and Safety
Code, as amended by this section, to be licensed under Chapter 245,
Health and Safety
Code, to obtain that license not later than January 1, 2004.
SECTION 2.57. Amends Section 252.202(a), Health and Safety Code, to
provide that a
quality assurance fee is imposed on each facility for which a license fee
must be paid under
Section 252.034, on each facility owned by a community mental health and
mental retardation
center, as described by Subchapter A, Chapter 534, and on each facility
owned by MHMR.
Provides that the fee is a certain amount, payable monthly, and is in
addition to other fees
imposed under this chapter.
SECTION 2.58. Amends Section 252.203, Health and Safety Code, to delete
text relating to certain beds on hold from the formula for determining the
number of patient days per calendar day for a facility.
SECTION 2.59. Amends Section 252.204(b), Health and Safety Code, to
require each facility to
take certain actions by certain dates.
SECTION 2.60. Amends Sections 252.207(a) and (c), Health and Safety Code,
as follows:
(a) Authorizes, rather than requires HHSC, subject to legislative
appropriation and state
and federal law, to use money in the quality assurance fund, together with
any federal
money available to match that money to offset expenses incurred to
administer the quality assurance fee under this chapter, to increase
reimbursement rates paid under the Medicaid program to facilities or
waiver programs for persons with mental retardation operated in accordance
with 42 U.S.C. Section 1396n(c) and its subsequent amendments, or for any
other health and human services purpose approved by the governor and LBB.
Deletes text referring to "allowable" expenses "under the Medicaid
program" and approval by the governor and LBB being "subject to Section
252.206(d)."
(c) Requires HHSC, if money in the quality assurance fund is used to
increase a
reimbursement rate in the Medicaid program, to ensure that the
reimbursement
methodology used to set that rate describes how the money in the fund will
be used to
increase the rate and provides incentives to increase direct care staffing
and direct care
wages and benefits. Deletes existing text relating to the formula devised
under
Subsection (b).
SECTION 2.61. Amends Section 253.008, Health and Safety Code, as follows:
Sec. 253.008. VERIFICATION OF EMPLOYABILITY. (a) Requires an agency
licensed under Chapter 142, or a person exempt from licensing under Section
142.003(a)(19), before hiring an employee, to search the employee
misconduct registry
under this chapter and the nurse aide registry maintained under the
Omnibus Budget
Reconciliation Act of 1987 (Pub. L. No. 100-203) to determine whether the
applicant for
employment, rather than the person, is designated in either registry as
having abused,
neglected, or exploited a resident or consumer of a facility or an
individual receiving
services from an agency licensed under Chapter 142 or from a person exempt
from
licensing under Section 142.003(a)(19). Makes conforming changes.
(b) Makes conforming and nonsubstantive changes.
SECTION 2.62. Amends Section 253.009(a), Health and Safety Code, to make
conforming and
nonsubstantive changes.
SECTION 2.63. (a) Amends Chapter 285, Health and Safety Code, by adding
Subchapter M, as
follows:
SUBCHAPTER M. PROVISION OF SERVICES
Sec. 285.201. PROVISION OF MEDICAL AND HOSPITAL CARE. Provides that as
authorized by 8 U.S.C. Section 1621(d), this chapter affirmatively
establishes eligibility
for a person who would otherwise be ineligible under 8 U.S.C. Section
1621(a), provided
that only local funds are utilized for the provision of nonemergency
public health
benefits. Provides that a person is not considered a resident of a
governmental entity or
hospital district if the person attempted to establish residence solely to
obtain health care
assistance.
(b) This sections effective date: upon passage or September 1, 2003.
SECTION 2.64. Amends Section 431.021(w), Health and Safety Code, to
provide that the act of
or the causing of the acceptance by a person, except as provided under
Subchapter M of this
chapter and Section 562.1085, Occupations Code, of an unused prescription
or drug, in whole or
in part, for the purpose of resale, after the prescription or drug has
been originally dispensed, or
sold is unlawful and prohibited.
SECTION 2.65. (a) Amends Section 461.018(b), Health and Safety Code, to
require that the Texas Commission on Alcohol and Drug Abuse's program
include establishing and maintaining a list of webpages and toll-free
"800" telephone numbers of nonprofit entities that provide crisis
counseling and referral services to families experiencing difficulty as a
result of problem or compulsive gambling, rather than establishing and
maintaining a toll-free "800" telephone number to provide such services.
(b) Repealer: Section 466.251(b) (Tickets), Government Code, and Section
2001.417(b)
(Toll-Free Help), Occupations Code.
SECTION 2.66. Amends Section 533.034, Health and Safety Code, as follows:
Sec. 533.034. AUTHORITY TO CONTRACT FOR COMMUNITY-BASED SERVICES. (a)
Creates this subsection from existing text.
(b) Authorizes MHMR to adopt a schedule of initial and annual renewal
compliance fees for persons that provide services under a home and
communitybased services waiver program for persons with mental retardation
adopted in accordance with Section 1915(c) of the federal Social Security
Act (42 U.S.C. Section 1396n), as amended, and that is funded wholly or
partly by MHMR and monitored by MHMR or by a designated local authority in
accordance with standards adopted by MHMR. Provides that this subsection
expires September 1, 2005.
SECTION 2.67. Amends Subchapter B, Chapter 533, Health and Safety Code, by
adding
Section 533.0354, as follows:
Sec. 533.0354. DISEASE MANAGEMENT PRACTICES AND JAIL DIVERSION
MEASURES OF LOCAL MENTAL HEALTH AUTHORITIES. (a) Requires a local
mental health authority to provide assessment services, crisis services,
and intensive and
comprehensive services using disease management practices for adults with
bipolar
disorder, schizophrenia, or clinically severe depression and for children
with serious
emotional illnesses. Requires the local mental health authority to engage
an individual
with certain treatment services that meet certain conditions.
(b) Requires MHMR to require each local mental health authority to
incorporate
jail diversion strategies into the authority's disease management
practices for
managing adults with schizophrenia and bipolar disorder to reduce the
involvement of those client populations with the criminal justice system.
(c) Requires MHMR to enter into performance contracts between MHMR and
each local mental health authority for the fiscal years ending August 31,
2004, and
August 31, 2005, that specify measurable outcomes related to their success
in
using disease management practices to meet the needs of the target
populations.
(d) Requires MHMR to study the implementation of disease management
practices, including the jail diversion measures, and to submit to the
governor, the
lieutenant governor, and the speaker of the house of representatives a
report on the
progress in implementing disease management practices and jail diversion
measures by local mental health authorities. Requires the report to be
delivered
not later than December 31, 2004, and to include specific information on
certain
items.
(e) Authorizes MHMR to use the fiscal year ending August 31, 2004, as a
transition period for implementing the requirements of Subsections (a)-(c).
SECTION 2.68. (a) Amends Subchapter B, Chapter 533, Health and Safety
Code, by adding
Section 533.049, as follows:
Sec. 533.049. PRIVATIZATION OF STATE SCHOOL. (a) Authorizes MHMR, after
August 31, 2004, and before September 1, 2005, to contract with a private
service
provider to operate a state school under certain circumstances.
(b) Requires MHMR, on or before April 1, 2004, to report to the
commissioner of health and human services whether MHMR has received a
proposal by a private service provider to operate a state school. Requires
the report to include an evaluation of the private service provider's
qualifications, experience, and financial strength, a determination of
whether the provider can operate the state school under the same standard
of care as MHMR, and an analysis of the projected savings under a proposed
contract with the provider. Requires the savings analysis to include all
MHMR costs to operate the state school, including costs, such as employee
benefits, that are not appropriated to MHMR.
(c) Requires MHMR, the Governor's Office of Budget and Planning, and the
LBB to identify sources of funding to be transferred to MHMR to fund the
contract, if MHMR contracts with a private service provider to operate a
state school.
(d) Authorizes MHMR to renew a contract under this section. Provides that
the
conditions listed in Subsections (a)(1)-(3) apply to the renewal of the
contract.
(b) Provides that Section 533.049, Health and Safety Code, as added by
this section,
takes effect September 1, 2004.
SECTION 2.69. (a) Amends Subchapter B, Chapter 533, Health and Safety
Code, by adding
Section 533.050, as follows:
Sec. 533.050. PRIVATIZATION OF STATE MENTAL HOSPITAL. (a) Authorizes
MHMR, after August 31, 2004, and before September 1, 2005, to contract
with a private
service provider to operate a state mental hospital owned by MHMR under
certain
conditions.
(b) Requires MHMR, on or before April 1, 2004, to report to the
commissioner of health and human services whether MHMR has received a
proposal by a private service provider to operate a state mental hospital.
Requires the report to include an evaluation of the private service
provider's qualifications, experience, and financial strength, a
determination of whether the provider can operate the hospital under the
same standard of care as MHMR, and an analysis of the projected savings
under a proposed contract with the provider. Requires the savings analysis
to include all MHMR costs to operate the hospital, including costs, such
as employee benefits, that are not appropriated to MHMR.
(c) Requires, if MHMR contracts with a private service provider to operate
a state
mental hospital, MHMR, the Governor's Office of Budget and Planning, and
the
LBB to identify sources of funding to be transferred to MHMR to fund the
contract.
(d) Authorizes MHMR to renew a contract under this section. Provides that
the
conditions listed in Subsections (a)(1)-(3) apply to the renewal of the
contract.
(b) Provides that Section 533.050, Health and Safety Code, as added by
this section,
takes effect September 1, 2004.
SECTION 2.70. (a) Amends Subchapter C, Chapter 533, Health and Safety
Code, by adding
Sections 533.061 and 533.0611, as follows:
Sec. 533.061. REQUIRED CONTRACT PROVISIONS. (a) Requires MHMR to include
in a contract with an intermediate care facility for the mentally retarded
(ICF-MR) program provider a provision stating that the contract
terminates if MHMR imposes a vendor hold on payments made to the facility
under the medical assistance program under Chapter 32, Human Resources
Code, three times during an 18-month period.
(b) Requires MHMR to ensure that each provision of a contract with an
ICF-MR program provider is consistent with MHMR and DHS rules that govern
the program.
Sec. 533.0611. SANCTIONS. Requires MHMR to immediately impose the vendor
hold
or terminate the contract, as appropriate, without conducting a further
investigation or
providing the program provider an opportunity to take corrective action,
if DHS recommends that a vendor hold be imposed on payments made to an
ICF-MR program provider or that the contract with the ICF-MR program
provider be terminated.
(b) Provides that a rule adopted by MHMR before September 1, 2003,
relating to the imposition of a vendor hold on payments made to an ICF-MR
program provider or the cancellation of a contract with an ICF-MR program
provider after the imposition of vendor holds, is repealed on September 1,
2003.
(c) Makes application of this Act prospective for Section 533.061, Health
and Safety Code, as added by this section.
SECTION 2.71. Amends Section 533.084, Health and Safety Code, by adding
Subsections (b-1)
and (b-2), as follows:
(b-1) Provides that, notwithstanding Subsection (b) or any other law, the
proceeds from
the disposal of any surplus real property by MHMR that occurs before
September 1,
2005, are not required to be deposited to the credit of MHMR in the Texas
capital trust
fund established under Chapter 2201, Government Code, and may be
appropriated for any
general governmental purpose.
(b-2) Provides that Subsection (b-1) and this subsection expire September
1, 2005.
SECTION 2.72. Amends Subchapter D, Chapter 533, Health and Safety Code, by
adding
Section 533.0844, as follows:
Sec. 533.0844. MENTAL HEALTH COMMUNITY SERVICES ACCOUNT. (a)
Provides that the mental health community services account is an account
in the general
revenue fund to be appropriated only for the provision of mental health
services by or
under contract with MHMR.
(b) Requires MHMR to deposit to the credit of the mental health community
services account any money donated to the state for inclusion in the
account,
including life insurance proceeds designated for deposit to the account.
(c) Requires interest earned on the mental health community services
account to
be credited to the account. Provides that the account is exempt from the
application of Section 403.095 (Use of Dedicated Revenue), Government Code.
SECTION 2.73. Amends Subchapter D, Chapter 533, Health and Safety Code, by
adding
Section 533.0846, as follows:
Sec. 533.0846. MENTAL RETARDATION COMMUNITY SERVICES ACCOUNT. (a) Provides
that the mental retardation community services account is an account in
the
general revenue fund to be appropriated only for the provision of mental
retardation
services by or under contract with MHMR.
(b) Requires MHMR to deposit to the credit of the mental retardation
community
services account any money donated to the state for inclusion in the
account,
including life insurance proceeds designated for deposit to the account.
(c) Requires that interest earned on the mental retardation community
services
account be credited to the account. Provides that the account is exempt
from the
application of Section 403.095, Government Code.
SECTION 2.74. Amends Section 572.0025(f), Health and Safety Code, as
follows:
(f) Provides that a prospective voluntary patient may not be formally
accepted for treatment in a facility unless: the facility has a
physician's order admitting the prospective patient, which order may be
issued orally, electronically, or in writing, signed by the physician,
provided that, in the case of an oral order or an electronically
transmitted unsigned order, a signed original is presented to the mental
health facility within 24 hours of the initial order. Requires the order
to be from an admitting physician who has, either in person or through the
use of audiovisual or other telecommunications technology, rather than
in-person, conducted a physical and psychiatric examination within 72
hours of the admission; or an admitting physician who has consulted with a
physician who has, either in person or through the use of audiovisual or
other telecommunications technology, rather than in-person, conducted an
examination within 72 hours of the admission; and that the facility
administrator or a person designated by the administrator has agreed to
accept the
prospective patient and has signed a statement to that effect.
SECTION 2.75. (a) Amends Section 773.050(c), Health and Safety Code, to
require each out-ofstate application for certification to be accompanied
by a nonrefundable fee of not more than $120, rather than $100, and
requires each out-of-country application for certification to be
accompanied by a nonrefundable fee of not more than $180, rather than
$150.
(b) Amends Section 773.052(a), Health and Safety Code, to authorize the
board to adopt a fee of not more than $30, rather than $25, for filing an
application for a variance.
(c) Amends Sections 773.054(c) and (d), Health and Safety Code, as
follows:
(c) Requires each application under Subsection (a)(3) to be accompanied by
a nonrefundable fee of not more than $30, rather than $25, for a program
instructor or examiner or $60, rather than $50 for a course coordinator.
(d) Requires each application under Subsection (a)(2) to be accompanied by
a nonrefundable fee of not more than $30, rather than $25, for a basic
course or training program or $60, rather than $50, for an advanced course
or training program.
(d) Amends Sections 773.055(a), (d), and (e), Health and Safety Code, as
follows:
(a) Requires a nonrefundable fee to accompany each application for
emergency medical services personnel certification. Prohibits the fee from
exceeding certain amounts.
(d) Requires that a fee of not more than $30, rather than $25, to
accompany each application for reexamination.
(e) Requires TDH to charge a fee of not more than $10, rather than $5, to
replace a lost certificate.
(e) Amends Section 773.056(b), Health and Safety Code, to require TDH to
charge a fee of not more than $10, rather than $5, to replace a lost or
stolen certificate.
(f) Amends Section 773.057(b), Health and Safety Code, to require a
nonrefundable application and vehicle fee determined by the board to
accompany each application. Provides that the application fee may not
exceed $500, rather than $150, for each application and the vehicle fee
may not exceed $180 for each emergency medical services vehicle operated
by the provider.
(g) Amends Section 773.0572, Health and Safety Code, as follows:
Sec. 773.0572. PROVISIONAL LICENSES. Requires a nonrefundable fee of not
more than $30, rather than $25, to accompany each application for a
provisional license.
(h) Amends Section 773.0611(c), Health and Safety Code, to require an
emergency medical services provider to pay to TDH a nonrefundable fee of
not more than $30, rather than $25, if reinspection is necessary to
determine compliance with this chapter and the rules adopted under this
chapter.
(i) Amends Section 773.065(c), Health and Safety Code, to prohibit the
penalty from exceeding $7,500, rather than $1,000, for each violation.
(j) Amends Subchapter C, Chapter 773, Health and Safety Code, by adding
Section 773.071, as follows:
Sec. 773.071. FEES. (a) Requires the board, by rule and to the extent
feasible, to set the fees under this subchapter in amounts necessary for
the department to recover the cost of administering this subchapter.
(b) Provides that Subsection (a) does not apply to fees for which Section
773.059 prescribes the method for determining the amount of the fees.
(k) Amends Sections 773.116(b) and (d), Health and Safety Code, as
follows:
(b) Prohibits the board from setting the amount of the fee schedule for
initial or continuing designation as a trauma facility according to the
number of beds in the health care facility from exceeding certain amounts.
(d) Requires the board, to the extent feasible, to set by rule the fee in
an amount necessary for TDH to recover the cost directly related to
designating trauma facilities under this subchapter. Deletes text
prohibiting the fee from exceeding a certain amount.
(l) Repealer: Section 773.116(c), (Fees), Health and Safety Code.
(m) Provides that the changes in law made by this section relating to
administrative penalties apply only to a violation that occurs on or after
the effective date of this section. For the purposes of this subsection,
an offense is committed before the effective date of this section if any
element of the offense occurs before that date. A violation that occurred
before the effective date of this section is covered by the law in effect
when the violation occurred, and the former law is continued in effect for
that purpose.
(n) Provides that the changes in law made by this section relating to fees
imposed under Chapter 773, Health and Safety Code, apply only to fees for
an application filed or an inspection conducted on or after the effective
date of this section. A fee for an application filed or an inspection
conducted before the effective date of this section is covered by the law
in effect when the application was filed or the inspection was conducted,
and the former law is continued in effect for that purpose.
SECTION 2.76. Amends Chapter 22, Human Resources Code, by adding Section
22.040, as
follows:
Sec. 22.040. THIRD-PARTY INFORMATION. Authorizes DHS, notwithstanding any
other provision of this code, to use information obtained from a third
party to verify the assets and resources of a person for purposes of
determining the person's eligibility and need for medical assistance,
financial assistance, or nutritional assistance. Provides that third-party
information includes information obtained from certain sources.
SECTION 2.77. (a) Amends Section 31.0031, Human Resources Code, by amending
Subsection (g) and adding Subsection (h), as follows:
(g) Defines "payee"and makes a nonsubstantive change.
(h) Requires DHS to require each payee to sign a bill of responsibilities
that defines the
responsibilities of the state and of the payee. Requires the
responsibility agreement to
require that a payee comply with the requirements of Subsections (d)(1),
(2), (5), (6), and
(7).
(b) Requires DHS, beginning September 1, 2003, to require each payee of
financial assistance under Chapter 31, Human Resources Code, to enter into
a responsibility agreement that complies with the requirements of Section
31.0031, Human Resources Code, as amended by this section, to continue
receiving that assistance. Requires each payee of financial assistance
under Chapter 31, Human Resources Code, who received that assistance on
behalf of a dependent child before September 1, 2003, to enter into a
responsibility agreement that complies with the requirements of Section
31.0031, Human Resources Code, as amended by this section, not later than
the date of the first eligibility review that occurs after September 1,
2003. Prohibits DHS from enforcing the terms of the new agreement until
the payee has an opportunity to enter into the agreement.
SECTION 2.78. Amends Section 31.0031(c), Human Resources Code, to require
DHS to adopt rules governing sanctions and penalties under this section to
or for a person who fails to cooperate, rather than comply, with each
applicable requirement of the responsibility agreement prescribed by this
section; and the family of a person who fails to cooperate with each
applicable requirement of the responsibility agreement.
SECTION 2.79. (a) Amends Sections 31.0032, 31.0033, and 31.0034, Human
Resources Code,
as follows:
Sec. 31.0032. New heading: PAYMENT OF ASSISTANCE AFTER PERFORMANCE.
(a) Requires DHS, except as provided by Section 231.115, Family Code, if
after an investigation DHS or the Title IV-D agency determines that a
person is not cooperating, rather than complying, with a requirement of
the responsibility agreement required under Section 31.0031, to
immediately apply a sanction terminating the total amount of financial
assistance provided under this chapter to or for the person and the
person's family, rather than apply appropriate sanctions or penalties
regarding the assistance provided to or for that person under this
chapter. Deletes text referencing Chapter 911, Acts of the 75th
Legislature, Regular Session, 1997.
(a-1) Requires DHS to apply a sanction or penalty imposed under Subsection
(a) for a period ending when the person demonstrates cooperation with the
requirement of the responsibility agreement for which the sanction was
imposed or for a one-month period, whichever is longer.
(b) Requires DHS to immediately notify the caretaker relative, second
parent, or
payee receiving the financial assistance if DHS will not make the financial
assistance payment for a one-month period because of a person's failure to
cooperate with the requirements of the responsibility agreement during that
month.
(c) Authorizes HHSC, or any health and human services agency, as defined by
Section 531.001, Government Code, to deny medical assistance for an
individual,
to the extent allowed by federal law, who is eligible for financial
assistance but to
whom that assistance is not paid because of the individual's failure to
cooperate.
Prohibits medical assistance to the person's family from being denied for
the
individual's failure to cooperate. Provides that this subsection prohibits
the denial
of medical assistance to persons receiving assistance under this chapter
under the
age of 19, pregnant adults, and any other person who may not be denied
medical
assistance under federal law.
(d) Creates this subsection from existing text to provide that this
section does not
prohibit the Texas Workforce Commission (TWC), HHSC, or any health and
human services agency, as defined by Section 531.001, Government Code,
rather
than DHS, from providing medical assistance, child care, or any other
social or
support services for an individual who is eligible for financial
assistance but to
whom that assistance is not paid because of the individual's failure to
cooperate.
(e) Requires DHS by rule to establish procedures to determine whether a
person
has cooperated with the requirements of the responsibility agreement
during each
one-month period.
Sec. 31.0033. New heading: GOOD CAUSE HEARING FOR FAILURE TO
COOPERATE. (a) Authorizes, if TDHS or Title IV-D agency determines that a
person
has failed to cooperate with the requirements of the responsibility
agreement under
Section 31.0031 during a one-month period, a person determined to have
failed to
cooperate or, if different, the person receiving the financial assistance
to request a hearing
to show good cause for failure to cooperate not later than the 13th day
after the date on
which notice is received under Section 31.0032. Prohibits DHS, if the
person
determined to have failed to cooperate or, if different, the person
receiving the financial
assistance requests a hearing to show good cause not later than the 13th
day after the date
on which notice is received under Section 31.0032, from withholding or
reducing the
payment of financial assistance until the 31st day after DHS receives the
request,
provided DHS completes the hearing before the 31st day, or the date the
hearing is
completed. Authorizes, on a showing of good cause for failure to
cooperate, a person to
receive a financial assistance payment for the month in which the person
failed to
cooperate.
(b) No change from existing text.
(c) Prohibits DHS, if DHS finds that good cause for the person's failure to
cooperate was not shown at a hearing, from making a financial assistance
payment
in any amount to the person for the person or the person's family for the
month in
which the person failed to cooperate.
(d) Replaces "noncompliance" with "failure to cooperate."
(e) Provides that, except as provided by a waiver or modification granted
under
Section 31.0322, a person has good cause for failing or refusing to
cooperate with
the requirement of the responsibility agreement under Section
31.0031(d)(1) only
if the person's cooperation would be harmful to the physical, mental, or
emotional
health of the person or the person's dependent child or the person's
noncooperation resulted from other circumstances the person could not
control.
Sec. 31.0034. ANNUAL REPORT. Includes in the information to be included in
DHS's annual report the number of persons who were eligible to receive
financial
assistance under this chapter for each one-month period but to whom that
financial
assistance was not paid because the person failed to cooperate with the
requirements of
the responsibility agreement under Section 31.0031. Removes reference to
"sanctions"
and replaces "comply" with "cooperate." Makes nonsubstantive changes.
(b) Amends Subchapter A, Chapter 31, Human Resources Code, by adding
Section
31.00331, as follows:
Sec. 31.00331. ADDITIONAL PENALTY FOR FAILURE TO COOPERATE. (a) Provides
that a person who fails to cooperate with the responsibility agreement for
two consecutive months becomes ineligible for financial assistance for the
person or the person's family. Authorizes the person to reapply for
financial assistance, but requires the person to cooperate with the
requirements of the responsibility agreement for a one-month period before
receiving an assistance payment for that month.
(c) Provides that changes in law made by this section apply to a person
receiving financial assistance under Chapter 31, Human Resources Code, on
or after the effective date of this section, regardless of the date on
which eligibility for financial assistance was determined.
SECTION 2.80. Amends Subchapter A, Chapter 31, Human Resources Code, by
adding Section
31.0038, as follows:
Sec. 31.0038. TEMPORARY EXCLUSION OF NEW SPOUSE'S INCOME. (a)
Prohibits income earned by an individual who marries an individual
receiving financial
assistance at the time of the marriage from being considered by DHS during
the six- month period following the date of the marriage for purposes of
determining the amount
of financial assistance granted to an individual under this chapter for
the support of
dependent children or whether the family meets household income and
resource
requirements for financial assistance under this chapter, subject to the
limitations
prescribed by Subsection (b).
(b) Provides that to be eligible for the income disregard provided by
Subsection
(a), the combined income of the individual receiving financial assistance
and the
new spouse cannot exceed 200 percent of the federal poverty level for
their family
size.
SECTION 2.81. Amends Sections 31.012(b) and (c), Human Resources Code, as
follows:
(b) Makes a conforming change.
(c) Deletes language referring to a single person who is the caretaker of
a child and the
requirement that the person participate in a program under this section.
SECTION 2.82. Amends Subchapter A, Chapter 31, Human Resources Code, by
adding Section
31.015, as follows:
Sec. 31.015. HEALTHY MARRIAGE DEVELOPMENT PROGRAM. (a) Requires
DHS, subject to available federal funding, to develop and implement a
healthy marriage
development program for recipients of financial assistance under this
chapter.
(b) Requires the healthy marriage development program to promote and
provide
three instructional courses on certain topics.
(c) Requires DHS to provide to a recipient of financial assistance under
this
chapter additional financial assistance of not more than $20 for the
recipient's
participation in a course offered through the healthy marriage development
program up to a maximum payment of $60 a month.
(d) Authorizes DHS to provide the courses or contract with any person,
including a community or faith-based organization, for the provision of the
courses. Requires DHS to provide all participants with an option of
attending
courses in a non-faith-based organization.
(e) Requires DHS to develop rules as necessary for the administration of
the
healthy marriage development program.
(f) Requires DHS to ensure that the courses provided by DHS and courses
provided through contracts with other organizations will be sensitive to
the needs
of individuals from different religions, races, and genders.
SECTION 2.83. (a) Amends Subchapter A, Chapter 302, Labor Code, by adding
Sections 302.0025, 302.0026, 302.0036, 302.0037, and 302.0038 as follows:
Sec. 302.0025. EMPLOYMENT PLAN AND POSTEMPLOYMENT STRATEGIES. (a) Requires
the Texas Workforce Commission (TWC) to ensure that an individual
employment plan developed for a recipient of financial assistance
participating in an employment program under Chapter 31, Human Resources
Code, includes specific postemployment strategies to assist the recipient
in making a transition to stable employment at a wage that enables the
recipient and the recipient's family to maintain selfsufficiency.
(b) Requires the individual employment plan to consider a recipient's
individual circumstances and needs in determining the recipient's initial
job placement; identify a target wage that enables the recipient and the
recipient's family to maintain self-sufficiency; provide specific
postemployment goals and include methods and time frames by which the
recipient is to achieve those goals; and refer the recipient to additional
educational and training opportunities.
Sec. 302.0026. EMPLOYMENT SERVICES REFERRAL PROGRAM. (a) Requires TWC and
local workforce development boards (LWDBs) to develop an employment
services referral program for recipients of financial assistance who
participate in employment programs under Chapter 31, Human Resources Code,
and have, in comparison to other recipients, higher levels of barriers to
employment. Requires the referral program to be designed to provide to a
recipient referrals to preemployment and postemployment services offered
by community-based organizations.
(b) Requires TWC and the LWDBs, subject to the availability of funds, in
developing the referral program, to coordinate partnerships and contract
with community-based organizations that provide employment services
specifically for persons with high levels of barriers to employment.
Sec. 302.0036. TRANSPORTATION ASSISTANCE. (a) Requires, to the extent
funds are available, TWC and LWDBs to provide transportation assistance to
recipients of financial assistance participating in employment programs
under Chapter 31, Human Resources Code, that enables the recipients to
maintain a stable work history and attain financial stability and
self-sufficiency.
(b) Authorizes TWC and LWDBs to provide the assistance described by
Subsection (a) by implementing new initiatives or expanding existing
initiatives that provide transportation assistance to recipients of
financial assistance for whom transportation is a barrier to employment.
Sec. 302.0037. MAXIMIZING FEDERAL FUNDS FOR TRANSPORTATION ASSISTANCE. (a)
Requires TWC and LWDBs to maximize the state's receipt of federal funds
available to provide transportation assistance to recipients of financial
assistance participating in employment programs under Chapter 31, Human
Resources Code.
(b) Authorizes TWC and LWDBs to, within any applicable appropriation
limits, take any action required by federal law to receive federal funds
to provide transportation assistance.
Sec. 302.0038. HOUSING RESOURCES FOR CERTAIN RECIPIENTS OF FINANCIAL
ASSISTANCE. (a) Requires TWC, in cooperation with LWDBs, for a recipient
of financial assistance participating in an employment program under
Chapter 31, Human Resources Code to identify unmet housing needs and
assess whether those needs are barriers to the recipient's full
participation in the workforce and attainment of financial stability and
self-sufficiency, and to develop a service plan that takes into
consideration the recipient's unmet housing needs.
(b) Requires TWC, by rule, to develop and implement a program through
which a recipient identified under Subsection (a) as having unmet housing
needs is referred by TWC or LWDBs to agencies and organizations providing
housing programs and services and connected to other housing resources.
Requires TWC, to provide those referrals and connections, to establish
collaborative partnerships between certain entities.
(c) Requires TWC to ensure that TWC and LWDB staff members receive
training regarding the programs and services offered by agencies and
organizations with which TWC establishes partnerships under Subsection (b)
and other available housing resources.
(b) Requires TWC and LWDBs, not later than December 1, 2003, to develop
the employment services referral program required by Section 302.0026,
Labor Code, as added by this section.
(c) Requires TWC, not later than December 1, 2003, to develop and
implement the program required by Section 302.0038(b), Labor Code, as
added by this section.
SECTION 2.84. Amends Section 302.011, Labor Code, as follows:
Sec. 302.011. New heading: POSTEMPLOYMENT CASE MANAGEMENT AND MENTORING.
Requires TWC to encourage LWDBs to provide postemployment case management
services for and use mentoring techniques to assist recipients of
financial assistance who participate in employment programs under Chapter
31, Human Resources Code, and have, in comparison to other recipients,
higher levels of barriers to employment. Requires the case management
services and mentoring techniques to be designed to increase the
recipient's potential for wage growth and development of a stable
employment history.
SECTION 2.85. Amends Subchapter B, Chapter 32, Human Resources Code, by
adding Section
32.0212, as follows:
Sec. 32.0212. DELIVERY OF MEDICAL ASSISTANCE. Requires HHSC or an agency
operating part of the medical assistance program, as appropriate, to
provide medical assistance for acute care through the Medicaid managed
care system implemented under Chapter 533, Government Code,
notwithstanding any other law and subject to Section 533.0025, Government
Code.
SECTION 2.86. (a) Amends Section 32.024, Human Resources Code, by adding
Subsections
(t-1), (z), and (z-1), as follows:
(t-1) Prohibits HHSC, in its rules governing the medical transportation
program, from
prohibiting a recipient of medical assistance from receiving
transportation services
through the program on the basis that the recipient resides in a nursing
facility.
(z) Authorizes HHSC, in its rules and standards governing the vendor drug
program, to
the extent allowed by federal law and if HHSC determines the policy to be
cost-effective,
to ensure that a recipient of prescription drug benefits under the medical
assistance
program does not, unless authorized by HHSC in consultation with the
recipient's
attending physician or advanced practice nurse, receive certain amounts of
prescription
drugs under the medical assistance program.
(z-1) Provides that Subsection (z) does not affect any other limit on
prescription
medications otherwise prescribed by department rule.
(b) Makes application of this Act prospective for Section 32.024(z), Human
Resources
Code, as added by this section.
SECTION 2.87. Amends Section 32.025(e), Human Resources Code, as follows:
(e) Requires HHSC or an agency operating part of the medical assistance
program, as appropriate, to permit an application requesting medical
assistance for a child under 19 years of age to be conducted by mail
instead of through a personal appearance at an HHSC office or the office
of an agency operating part of the medical assistance program, as
appropriate, unless HHSC determines that the information needed to verify
eligibility cannot be obtained in that manner. Authorizes HHSC to by rule
develop procedures requiring an application for a child described by this
subsection to be conducted through a personal interview with a department
representative if the department determines that information needed to
verify eligibility cannot be obtained in any other manner.
SECTION 2.88. Amends Section 32.026, Human Resources Code, by amending
Subsection (e) and adding Subsection (g), as follows:
(e) Requires HHSC to permit a recertification review of the eligibility
and need for medical assistance of a child under 19 years of age to be
conducted by a person-to-person telephone interview or through a
combination of a telephone interview and mail correspondence instead of
through a personal appearance at an HHSC office or the office of an agency
operating part of the medical assistance program, as appropriate, unless
HHSC determines that the information needed to verify eligibility cannot
be obtained in that manner. Authorizes HHSC to by rule develop procedures
requiring an application for a child described by this subsection to be
conducted through a personal interview with a department representative if
the department determines that information needed to verify eligibility
cannot be obtained in any other manner.
(g) Prohibits HHSC or an agency operating part of the medical assistance
program, as appropriate, if a person is applying for long-term care
services through the medical assistance program, from determining and
certifying the person's eligibility and need for medical assistance unless
the person has applied for and obtained any benefits and services for
which the person is eligible through the Department of Veterans Affairs.
SECTION 2.89. Amends Section 32.0315(a), Human Resources Code, to make
this section
subject to appropriated state funds.
(b) Repealer: Sections 32.0315(d)-(h) (Funds for Graduate Medical
Education), Human Resources Code.
SECTION 2.90. Amends Section 10(c), Chapter 584, Acts of the 77th
Legislature, Regular
Session, 2001, to change the date to September 1, 2005, rather than June
1, 2003, in relation to the effective date of the rules relating to
eligibility periods.
SECTION 2.91. Amends Section 32.028, Human Resources Code, by adding
Subsections (i), (j),
(k), and (l), as follows:
(i) Requires HHSC to adopt rules governing the determination of the amount
of
reimbursement or credit for restocking drugs under Section 562.1085,
Occupations Code, that recognize the costs of processing the drugs,
including the cost of reporting the drug's prescription number and date of
original issue verifying whether the drug's expiration date or the drug's
recommended shelf life exceeds 120 days determining the source of payment
and preparing credit records.
(j) Requires HHSC to provide an electronic system for the issuance of
credit for
returned drugs that complies with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), Pub. L. No. 104-191, as amended.
Provides that, to ensure a cost-effective system, only drugs for which the
credit exceeds the cost of the restocking fee by at least 100 percent are
eligible for credit.
(k) Requires HHSC to establish a task force to develop the rules necessary
to implement Subsections (i) and (j). Requires the task force to include
representatives of nursing facilities and pharmacists.
(b) Requires HHSC to adopt the rules required by Sections 32.028(i) and
(j), Human Resources Code, as added by this section, not later than
December 1, 2003.
SECTION 2.92. Amends Subchapter B, Chapter 32, Human Resources Code, by
adding Section
32.0291, as follows:
Sec. 32.0291. PREPAYMENT REVIEWS AND POSTPAYMENT HOLDS. (a)
Authorizes HHSC, notwithstanding any other law, to: perform a prepayment
review of a
claim for reimbursement under the medical assistance program to determine
whether the
claim involves fraud or abuse; and as necessary to perform that review,
withhold payment
of the claim for not more than five working days without notice to the
person submitting
the claim.
(b) Authorizes HHSC, notwithstanding any other law, to impose a postpayment
hold on payment of future claims submitted by a provider if HHSC has
reliable
evidence that the provider has committed fraud or wilful misrepresentation
regarding a claim for reimbursement under the medical assistance program.
Requires HHSC to notify the provider of the postpayment hold not later
than the
fifth working day after the date the hold is imposed.
(c) Requires HHSC, on timely written request by a provider subject to a
postpayment hold under Subsection (b), to file a request with the State
Office of Administrative Hearings for an expedited administrative hearing
regarding the hold. Requires the provider to request an expedited
hearing under this subsection not later than the10th day after the date
the provider receives notice from HHSC under Subsection (b). Requires HHSC
to discontinue the hold unless HHSC makes a prima facie showing at the
hearing that the evidence relied on by HHSC in imposing the hold is
relevant, credible, and material to the issue of fraud or wilful
misrepresentation.
(d) Requires HHSC to adopt rules that allow a provider subject to a
postpayment hold under Subsection (b) to seek an informal resolution of
the issues identified by HHSC in the notice provided under that
subsection. Requires a provider to seek an informal resolution under this
subsection not later than the deadline prescribed by Subsection (c).
Provides that a provider's decision to seek an informal resolution under
this subsection does not extend the time by which the provider must
request an expedited administrative hearing under Subsection (c), however,
requires a hearing initiated under Subsection (c) to be stayed at HHSC's
request until the informal resolution process is completed.
SECTION 2.93. Amends Section 32.032, Human Resources Code, as follows:
Sec. 32.032. New heading: PREVENTION AND DETECTION OF FRAUD AND
ABUSE. Makes conforming changes.
SECTION 2.94. Amends Section 32.0321, Human Resources Code, as follows:
Sec. 32.0321. SURETY BOND. (a) Requires HHSC by rule to require a provider
of
medical assistance to file with TDHS a surety bond in a reasonable amount
if HHSC
identifies a pattern of suspected fraud or abuse involving criminal
conduct relating to the
provider's services under the medical assistance program that indicates
the need for
protection against potential future acts of fraud or abuse.
(b) Makes a conforming change.
(c) Authorizes TDHS, subject to Subsection (d) or (e), by rule to require
each
provider of medical assistance that establishes a resident's trust fund
account to
post a surety bond to secure any shortages in the account. Requires the
bond to be
payable to TDHS to compensate residents of the bonded provider for trust
funds
that are lost, stolen, or otherwise unaccounted for if the provider does
not repay
any deficiency in a resident's trust fund account to the person legally
entitled to
receive the funds.
(d) Prohibits TDHS from requiring the amount of a surety bond posted for a
single facility provider under Subsection (c) to exceed the average of the
total
average monthly balance of all the provider's resident trust fund accounts
for the
12-month period preceding the bond issuance or renewal date.
(e) Provides that if an employee of a provider of medical assistance is
responsible for the loss of funds in a resident's trust fund account, the
resident, the resident's family, and the resident's legal representative
are not obligated to make any payments to the provider that would have
been made out of the trust fund had the loss not occurred.
SECTION 2.95. (a) Amends Subchapter B, Chapter 32, Human Resources Code,
by adding
Section 32.0423, as follows:
Sec. 32.0423. RECOVERY OF REIMBURSEMENTS FROM HEALTH COVERAGE
PROVIDERS. Requires, to the extent allowed by federal law, a health care
service
provider to seek reimbursement from available third-party health coverage
or insurance
that the provider knows about or should know about before billing the
medical assistance
program.
(b) Makes application of this Act prospective for Section 32.0423, Human
Resources Code, as added by this section.
SECTION 2.96. (a) Amends Subchapter B, Chapter 32, Human Resources Code,
by adding
Section 32.0462, as follows:
Sec. 32.0462. MEDICATIONS AND MEDICAL SUPPLIES. Authorizes HHSC to
adopt rules establishing procedures for the purchase and distribution of
medically
necessary, over-the-counter medications and medical supplies under the
medical
assistance program that were previously being provided by prescription if
HHSC
determines it is more cost-effective than obtaining those medications and
medical
supplies through a prescription.
(b) Requires HHSC, not later than January 1, 2004, to submit a report to
the clerks of the
standing committees of the senate and house of representatives with
jurisdiction over the
state Medicaid program describing the status of any cost savings generated
by purchasing
over-the-counter medications and medical supplies as provided by Section
32.0462,
Human Resources Code, as added by this section. Requires the report to be
updated not
later than January 1, 2005.
SECTION 2.97. Amends Section 32.050, Human Resources Code, by adding
Subsection (d), (e), and (f), as follows:
(d) Requires, except as provided by Subsection (e), a nursing facility, a
home health services provider, or any other similar long-term care
services provider, that is Medicarecertified and provides care to
individuals who are eligible for Medicare to seek reimbursement from
Medicare before billing the medical assistance program for services
provided to an individual identified under Subsection (a) and as directed
by HHSC, appeal Medicare claim denials for payment services provided to an
individual identified under Subsection (a).
(e) Provides that a home health services provider is not required to seek
reimbursement from Medicare before billing the medical assistance program
for services provided to a person who is eligible for Medicare and who has
been determined as not being homebound or meets other criteria determined
by HHSC.
(f) Authorizes, if the Medicare reimbursement rate for a service provided
to an individual identified under Subsection (a) exceeds the medical
assistance reimbursement rate for a comparable service, the medical
assistance program to not pay a Medicare coinsurance or deductible amount
for that service.
SECTION 2.98. (a) Amends Subchapter B, Chapter 32, Human Resources Code,
by adding
Section 32.060, as follows:
Sec. 32.060. NURSING FACILITY QUALITY ASSURANCE TEAM. (a) Provides that
the nursing facility quality assurance team (team) is established to make
recommendations to HHSC designed to promote high-quality care for
residents of nursing facilities.
(b) Provides that the team is composed of nine particular members
appointed by the governor and the state long-term care ombudsman, who
serves as an ex officio, nonvoting member of the team.
(c) Requires the governor to designate a member of the team, other than
the state long-term care ombudsman, to serve as presiding officer.
Requires the members of the team to elect any other necessary officers.
(d) Requires the team to meet at the call of the presiding officer.
(e) Provides that a member of the team serves at the will of the governor.
(f) Prohibits a member of the team from receiving compensation for serving
on
the team but entitles the team member to reimbursement for travel expenses
incurred by the member while conducting the business of the team as
provided by the General Appropriations Act.
(g) Requires the team to develop and recommend clearly defined minimum
standards to be considered for inclusion in contracts between HHSC, or an
agency operating part of the medical assistance program, as appropriate,
and nursing
facilities for the delivery of medical assistance under this chapter that
are designed
to: ensure that the care provided by nursing facilities to residents who
are
recipients of medical assistance meets or exceeds the minimum acceptable
standard of care; and encourage nursing facilities to provide the highest
quality of
care to those residents; and to develop and recommend improvements to
consumers' access to information regarding the quality of care provided by
nursing
facilities that contract with HHSC or an agency operating part of the
medical assistance program, as appropriate, to provide medical assistance,
including certain
improvements.
(h) Requires the team, in developing minimum standards for contracts as
required
by Subsection (g)(1), to perform certain tasks.
(i) Requires HHSC to ensure the accuracy of information provided to the
team for
use by the team in performing the team's duties under this section.
Requires
HHSC to provide administrative support and resources to the team and
request
additional administrative support and resources from health and human
services
agencies as necessary.
(b) Requires the governor to appoint the members of the team established
under Section
32.060, Human Resources Code, as added by this section, not later than
January 1, 2004.
(c) Requires the team to develop and make the recommendations required by
Section
32.060, Human Resources Code, as added by this section, not later than May
1, 2004.
(d) Requires team to report on its work and recommendations to the
governor and the
LBB no later than October 1, 2004, for consideration by the 79th
Legislature.
SECTION 2.99. Amends Subchapter B, Chapter 32, Human Resources Code, by
adding
Section 32.061, as follows:
Sec. 32.061. COMMUNITY ATTENDANT SERVICES PROGRAM. Requires any
home and community-based services that HHSC provides under Section 1929,
Social
Security Act (42 U.S.C. Section 1396t) and its subsequent amendments to
functionally
disabled individuals who have income that exceeds the limit established by
federal law
for Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et seq.)
and its
subsequent amendments to be provided through the community attendant
services
program.
SECTION 2.100. (a) Amends Subchapter B, Chapter 32, Human Resources Code,
by adding
Section 32.063, as follows:
Sec. 32.063. THIRD-PARTY BILLING VENDORS. (a) Prohibits a third-party
billing
vendor from submitting a claim with HHSC for reimbursement on behalf of a
provider of
medical services under the medical assistance program unless the vendor
has entered into
a contract with HHSC authorizing that activity.
(b) Requires, to the extent practical, the contract to contain provisions
comparable to the provisions contained in contracts between HHSC and
providers of medical services, with an emphasis on provisions designed to
prevent fraud or abuse under the medical assistance program. Requires, at
a minimum, the contract to require the third-party billing vendor to
perform certain functions.
(c) Requires HHSC, on receipt of a claim submitted by a third-party
billing vendor, to send a remittance notice directly to the provider
referenced in the claim. Requires the notice to include detailed
information regarding the claim submitted on behalf of the provider.
(d) Requires HHSC to take all action necessary, including any
modifications of
HHSC's claims processing system, to enable HHSC to identify and verify a
thirdparty billing vendor submitting a claim for reimbursement under the
medical
assistance program, including identification and verification of any
computer or
telephone line used in submitting the claim, any relevant user password
used in
submitting the claim, and any provider number referenced in the claim.
(e) Requires HHSC to audit each third-party billing vendor subject to this
section
at least annually to prevent fraud and abuse under the medical assistance
program.
(b) Provides that Section 32.063, Human Resources Code, as added by this
section, takes
effect January 1, 2004.
SECTION 2.101. (a) Amends Subchapter B, Chapter 32, Human Resources Code,
by adding
Section 32.064, as follows:
Sec. 32.064. COST SHARING. (a) Requires HHSC, to the extent permitted
under Title
XIX, Social Security Act (42 U.S.C. Section 1396 et seq.), as amended, and
any other
applicable law or regulations, to adopt provisions requiring recipients of
medical
assistance to share the cost of medical assistance, including provisions
requiring
recipients to pay certain costs.
(b) Requires cost-sharing provisions adopted under this section to ensure
that
families with higher levels of income are required to pay progressively
higher
percentages of the cost of the medical assistance, subject to Subsection
(d).
(c) Requires HHSC to specify the manner in which the premium is paid, if
cost sharing provisions imposed under Subsection (a) include requirements
that
recipients pay a portion of the plan premium. Authorizes HHSC to require
that
the premium be paid to HHSC, an agency operating part of the medical
assistance
program, or the Medicaid managed care plan.
(d) Authorizes cost-sharing provisions adopted under this section to be
determined based on the maximum level authorized under federal law and
applied
to income levels in a manner that minimizes administrative costs.
(b) Makes application of this Act prospective for Section 32.064, Human
Resources
Code.
SECTION 2.102. Amends Section 48.401(1), Human Resources Code, to redefine
"agency."
SECTION 2.103. Amends Section 73.0051, Human Resources Code, by adding
Subsection (l) to
authorize the Interagency Council on Early Childhood Intervention by rule
to establish a system
of payments by families of children receiving services under this chapter,
including a schedule of
sliding fees, in a manner consistent with 34 C.F.R. Sections
303.12(a)(3)(iv), 303.520, and
303.521.
SECTION 2.104. (a) Amends Sections 91.027(a) and (b), Human Resources
Code, as follows:
(a) Requires HHSC, to the extent that funds are available under Sections
521.421(f), as added by Chapter 510, Acts of the 75th Legislature, Regular
Session, 1997, and 521.422(b), Transportation Code, to operate, rather
than develop, a Blindness Education, Screening, and Treatment Program to
provide certain services.
(b) Requires HHSC to include transition services along with other
services. Deletes language requiring HHSC to implement the program only to
the extent that funds are available under Section 521.421(f),
Transportation Code.
(b) Requires the Texas Commission for the Blind to establish the
consolidated program
under Section 91.027, Human Resources Code, as amended by this section,
not later than
the 90th day after the effective date of this section.
SECTION 2.105. (a) Amends Section 111.052, Human Resources Code, as
follows:
Sec. 111.052. GENERAL FUNCTIONS. (a) Deletes "an extended rehabilitation
services program" as a program established to provide rehabilitative
services.
(b) Includes assessing the statewide need for services necessary to
prepare students with disabilities for a successful transition to
employment, establishing collaborative relationships with each school
district with education service centers to the maximum extent possible
within available resources, and developing strategies to assist vocational
rehabilitation counselors in identifying and reaching students in need of
transition planning to the authority of HHSC. Deletes "contract with a
public or private agency to provide and pay for rehabilitative services
under the extended rehabilitation services program, including alternative
sheltered employment or community integrated employment for a person
participating in the program" from HHSC's authority.
(b) Repealer: Sections 111.002(7) (Definitions), 111.0525(a) (Coordination
with State
Agencies), and 111.073 (Transition Planning), Human Resources Code.
SECTION 2.106. Amends Section 111.060, Human Resources Code, by adding
Subsection (d)
to authorize any money in the comprehensive rehabilitation fund
notwithstanding any other provision of this section to be used for general
governmental purposes under certain conditions.
SECTION 2.107. (a) Provides that Subchapter I, Chapter 264, Family Code,
is transferred to
Chapter 33, Education Code, redesignated as Subchapter E, Chapter 33,
Education Code, and
amended as follows:
SUBCHAPTER E. COMMUNITIES IN SCHOOLS PROGRAM
Sec. 33.151. DEFINITIONS. Defines "department," "communities in schools
program,"
"delinquent conduct," and "student at risk of dropping out of school."
Sec. 33.152. STATEWIDE OPERATION OF PROGRAM. Includes "as that chapter
existed on August 31, 1999" in reference to Chapter 305, Labor Code.
Replaces
"department" with "agency."
Sec. 33.153. STATE DIRECTOR. Requires the commissioner of education,
rather than
the executive director of the department, to designate a state director
for the Communities
In Schools program.
Sec. 33.154. DUTIES OF STATE DIRECTOR. No changes to this section.
Sec. 33.155. New heading: DEPARTMENT COOPERATION; MEMORANDUM OF
UNDERSTANDING.
(b) Deletes the term "mutually" as a modifier to "agree" in reference to a
memorandum of understanding. Makes conforming and nonsubstantive changes.
Sec. 33.156. FUNDING; EXPANSION OF PARTICIPATION. Makes a conforming
change.
Sec. 33.157. PARTICIPATION IN PROGRAM. Requires an elementary or secondary
school receiving funding under Section 33.156 to participate in a local
Communities In
Schools program if the number of students enrolled in the school who are
at risk of
dropping out of school is equal to at least 10 percent of the number of
students in average
daily attendance at the school, as determined by the Texas Education
Agency. Makes a
conforming change.
Sec. 33.158. DONATIONS TO PROGRAM. (a) Makes conforming changes.
(b) Amends Section 302.062(g), Labor Code, to make conforming changes.
(c) Provides that on September 1, 2003:
(1) all powers, duties, functions, and activities relating to the
Communities In Schools (CIS) program assigned to or performed by the
Department of Protective Services (DPRS) immediately before September 1,
2003, are transferred to the Texas Education Agency (TEA);
(2) all funds, rights, obligations, and contracts of the DPRS related to
the CIS program are transferred to the TEA for the CIS program;
(3) all property and records in the custody of the DPRS related to the CIS
program and all funds appropriated by the legislature for the CIS program
are transferred to the TEA for the CIS program; and
(4) all employees of the DPRS who primarily perform duties related to the
CIS program become employees of the TEA, to be assigned duties related to
the CIS program.
(d) Provides that for the 2003 and 2004 state fiscal years, all full-time
equivalent
positions (FTEs) authorized by the General Appropriations Act for the CIS
program are transferred to the TEA and are not included in determining the
agency's compliance with any limitation on the number of full-time
equivalent positions (FTEs) imposed by the General Appropriations Act.
(e) Provides that a reference in law or administrative rule to the DPRS
that relates to the CIS program means the TEA. Provides that a reference
in law or administrative rule to the executive director of the DPRS that
relates to the CIS program means the commissioner of education.
(f) Provides that a rule of the DPRS relating to the CIS program continues
in effect as a rule of the commissioner of education until superseded by
rule of the commissioner of education. Provides that the secretary of
state is authorized to adopt rules as necessary to expedite the
implementation of this subsection.
(g) Provides that the transfer of the CIS program and associated powers,
duties,
functions, and activities under this section does not affect or impair any
act done, any obligation, right, order, license, permit, rule, criterion,
standard, or requirement existing, any investigation begun, or any penalty
accrued under former law, and that law remains in effect for any action
concerning those matters.
(h) Makes application of this Act prospective.
SECTION 2.108. (a) Amends Sections 2(a) and (c), Article 4.11, Insurance
Code, to redefine
"carrier" and "gross premiums."
(b) Provides that the change in law made by this section applies only to a
tax report
originally due on or after January 1, 2004.
(c) Provides that the change in law made by this section expires December
31, 2007.
SECTION 2.109. (a) Amends Article 4.17(a), Insurance Code, to delete
references to "this
state" in relation to gross premiums. Deletes "for the purpose of
providing welfare benefits to
designated welfare recipients or for insurance contracted for by this
state or the United States." Makes conforming changes.
(b) Provides that the change in law made by this section applies only to a
tax report
originally due on or after January 1, 2004.
(c) Provides that the change in law made by this section expires December
31, 2007.
SECTION 2.110. (a) Amends Section 20A.33(d), Texas Health Maintenance
Organization Act
(Article 20A.33, Vernon's Texas Insurance Code), to make conforming
changes.
(b) Provides that the change in law made by this section applies only to a
tax report
originally due on or after January 1, 2004.
(c) Provides that the change in law made by this section expires December
31, 2007.
SECTION 2.111. Amends Section 2, Article 21.52K, Insurance Code, by
amending Subsections
(c) and (d) and adding Subsection (g), as follows:
(c) Includes on receipt of "request" in relation to enrolling in the plan.
Makes
conforming changes.
(d) Makes conforming changes.
(g) Requires the issuer of a group health benefit plan to permit an
individual who is
otherwise eligible for enrollment in the plan to enroll in the plan
without regard to any
enrollment period restriction if the individual becomes ineligible for
medical assistance
under the state Medicaid program or enrollment in the state child health
plan under
Chapter 62, Health and Safety Code, after initially establishing
eligibility and provides a
written request for enrollment in the group health benefit plan not later
than the 30th day
after the date the individual's eligibility for the state Medicaid program
or the state child
health plan terminated.
SECTION 2.112. (a) Amends Article 21.53F, Insurance Code, as added by
Chapter 683, Acts of
the 75th Legislature, Regular Session, 1997, by adding Section 9, as
follows:
Sec. 9. OFFER OF COVERAGE REQUIRED; CERTAIN THERAPIES FOR
CHILDREN WITH DEVELOPMENTAL DELAYS. (a) Provides that for purposes of
this section, rehabilitative and habilitative therapies include certain
evaluations and
services.
(b) Requires the issuer of a health benefit plan to offer coverage that
complies
with this section. Authorizes the individual or group policy or contract
holder to
reject coverage required to be offered under this subsection.
(c) Prohibits a health benefit plan that provides coverage for
rehabilitative and
habilitative therapies under this section from prohibiting or restricting
payment for
covered services provided to a child and determined to be necessary to and
provided in accordance with an individualized family service plan issued
by the
Interagency Council on Early Childhood Intervention under Chapter 73, Human
Resources Code.
(d) Requires rehabilitative and habilitative therapies described by
Subsection (c)
of this section be covered in the amount, duration, scope, and service
setting
established in the child's individualized family service plan.
(e) Prohibits, under the coverage required to be offered under this
section, a
health benefit plan issuer from performing certain actions.
(b) Makes application of this section prospective to January 1, 2004.
SECTION 2.113. Amends Article 27.05, Insurance Code, as follows:
Art. 27.05. EXEMPTION FROM PREMIUM TAX. Provides that a health benefit plan
be approved under Article 27.03 of this code.
SECTION 2.114. Amends Chapter 27, Insurance Code, by adding Article 27.07,
as follows:
Art. 27.07. INAPPLICABILITY TO CERTAIN PLANS. Provides that this chapter
does
not apply to a health benefit plan provided under the state Medicaid
program or the state
child health plan.
SECTION 2.115. Amends Subchapter C, Chapter 562, Occupations Code, by
adding Sections
562.1085 and 562.1086, as follows:
Sec. 562.1085. UNUSED DRUGS RETURNED BY CERTAIN PHARMACISTS. (a)
Authorizes a pharmacist who practices in or serves as a consultant for a
health care
facility in this state to return to a pharmacy certain unused drugs, other
than a controlled
substance as defined by Chapter 481, Health and Safety Code, purchased
from the pharmacy as provided by Texas State Board of Pharmacy (TSBP)
rule. Requires the unused drugs to be approved by the federal Food and
Drug Administration and meet certain other requirements.
(b) Requires a pharmacist for the pharmacy to examine a drug returned
under this section to ensure the integrity of the drug product. Prohibits
a health care facility from returning certain drugs.
(c) Authorizes the pharmacy to restock and redistribute unused drugs
returned under this section.
(d) Requires the pharmacy to reimburse or credit the state Medicaid
program for an unused drug returned under this section.
(e) Requires TSBP to adopt the rules, policies, and procedures necessary
to administer this section, including rules that require a health care
facility to inform HHSC of medicines returned to a pharmacy under this
section.
Sec. 562.1086. LIMITATION ON LIABILITY. (a) Provides that a pharmacy that
returns
unused drugs and a manufacturer that accepts the unused drugs under
Section 562.1085
and the employees of the pharmacy or manufacturer are not liable for harm
caused by the
accepting, dispensing, or administering of drugs returned in strict
compliance with Section 562.1085 unless the harm is caused by wilful or
wanton acts of negligence, conscious indifference or reckless disregard
for the safety of others or intentional conduct.
(b) Provides that this section does not limit, or in any way affect or
diminish, the
liability of a drug seller or manufacturer under Chapter 82, Civil
Practice and
Remedies Code.
(c) Provides that this section does not apply if harm results from the
failure to
fully and completely comply with the requirements of Section 562.1085.
(d) Provides that this section does not apply to a pharmacy or
manufacturer that
fails to comply with the insurance provisions of Chapter 84, Civil
Practice and
Remedies Code.
SECTION 2.116. Amends Section 455.0015, Transportation Code, by amending
Subsection (b)
and adding Subsections (c)-(g), as follows:
(b) Provides that the legislature likewise recognizes the potential cost
savings and other
benefits for utilizing existing private sector transportation resources.
Provides that the
Texas Department of Transportation (TxDOT) will contract with and promote
the use of
private sector transportation resources to the maximum extent feasible
consistent with the
goals of this subsection.
(c) Requires the TDH and HHSC to contract with TxDOT for TxDOT to assume
all
responsibilities of TDH and HHSC relating to the provision of
transportation services for
clients of eligible programs. Requires TxDOT to hold at least one public
hearing to solicit the views of the public concerning the transition of
transportation services under this subsection and shall meet with and
consider the views of interested persons, including persons representing
transportation clients.
(d) Authorizes TxDOT to contract with an appropriate number of regional
transportation brokers for administrative assistance in providing
transportation services under the medical transportation program. Requires
TxDOT, in designing the medical transportation program, and in determining
the appropriate number of regions, to consider overall cost control,
access to services, and service quality.
(e) Authorizes TxDOT to contract under Subsection (d) with any person or
organization that meets the criteria established by TxDOT, including a
nonprofit organization, public entity, or private contractor.
(f) Requires a contract under Subsection (d) between TxDOT and a broker to
contain certain requirements.
(g) Authorizes a broker selected by TxDOT to contract with transportation
providers as necessary to provide transportation services to persons
eligible for those services. Requires TxDOT to encourage each broker to
make maximum use of existing service providers in each region.
SECTION 2.117. Amends Section 40.002, Human Resources Code, by adding
Subsection (f), to
authorize HHSC to contract with TxDOT for TxDOT to assume all
responsibilities of HHSC
relating to the provision of transportation services for clients of
eligible programs.
SECTION 2.118. Amends Section 22.001, Human Resources Code, by adding
Subsection (e), to
require HHSC to contract with TxDOT for TxDOT to assume all
responsibilities of HHSC
relating to the provision of transportation services for clients of
eligible programs.
SECTION 2.119. Amends Section 91.021, Human Resources Code, by adding
Subsection (g) to
require HHSC to contract with TxDOT for TxDOT to assume all
responsibilities of HHSC
relating to the provision of transportation services for clients of
eligible programs.
SECTION 2.120. Amends Section 101.0256, Human Resources Code, as follows:
Sec. 101.0256. COORDINATED ACCESS TO LOCAL SERVICES. (a) Creates this
subsection from existing text.
(b) Makes a conforming change.
SECTION 2.121. Amends Section 111.0525, Human Resources Code, by adding
Subsection (d),
to make a conforming change.
SECTION 2.122. Amends Section 461.012(a), Health and Safety Code, to
include: "contract with TxDOT for TxDOT to assume all responsibilities of
HHSC relating to the provision of transportation services for clients of
eligible programs" as a required duty of HHSC. Makes a nonsubstantive
change.
SECTION 2.123. Amends Section 533.012, Health and Safety Code, as follows:
Sec. 533.012. COOPERATION OF STATE AGENCIES. (a) Creates this subsection
from existing text.
(b) Requires MHMR to contract with TxDOT for TxDOT to assume all
responsibilities of MHMR relating to the provision of transportation
services for
clients of eligible programs.
SECTION 2.124. (a) Amends Section 1551.159, Insurance Code, as effective
June 1, 2003, by
amending Subsection (a) and adding Subsection (h), as follows:
(a) Replaces "the program established by the state to implement Title XXI,
Social
Security Act (42 U.S.C. Section 1397aa et seq.), as amended" with "the
state child
health plan established under Chapter 62, Health and Safety Code" in
relation to a
child's insurance coverage.
(h) Provides that a child enrolled in dependent child coverage under this
section
is subject to the same requirements and restrictions relating to income
eligibility,
continuous coverage, and enrollment, including applicable waiting periods,
as a
child enrolled in the state child health plan under Chapter 62, Health and
Safety
Code.
(b) Makes application of this section prospective as applies to a child
enrolled in
dependent child coverage under the state employees group benefits program
on or after September 1, 2003.
SECTION 2.125. Amends Section 31.03, Penal Code, by adding Subsection (j)
to provide that
with the consent of the appropriate local county or district attorney, the
attorney general has
concurrent jurisdiction with that consenting local prosecutor to prosecute
an offense under this
section that involves the state Medicaid program.
SECTION 2.126. Amends Section 32.45, Penal Code, by adding Subsection (d)
to provide that
with the consent of the appropriate local county or district attorney, the
attorney general has
concurrent jurisdiction with that consenting local prosecutor to prosecute
an offense under this
section that involves the state Medicaid program.
SECTION 2.127. Amends Section 32.46, Penal Code, by adding Subsection (e)
to provide that
with the consent of the appropriate local county or district attorney, the
attorney general has
concurrent jurisdiction with that consenting local prosecutor to prosecute
an offense under this
section that involves the state Medicaid program.
SECTION 2.128. Amends Section 37.10, Penal Code, by adding Subsection (i)
to provide that
with the consent of the appropriate local county or district attorney,
the attorney general has
concurrent jurisdiction with that consenting local prosecutor to prosecute
an offense under this
section that involves the state Medicaid program.
SECTION 2.129. Amends Section 57.046, Utilities Code, by adding Subsection
(c) to authorize
the Telecommunications Infrastructure Fund Board to use money in the
account to award grants
to HHSC for technology initiatives of Public Utility Commission, in
addition to the purposes for
which the qualifying entities account may be used.
SECTION 2.130. Amends Articles 59.01(1) and (2), Code of Criminal
Procedure, to redefine
"attorney representing the state" and "contraband."
SECTION 2.131. Amends Article 59.06, Code of Criminal Procedure, by adding
Subsection (p)
to require the attorney representing the state to transfer to HHSC all
forfeited property defined as
contraband under Article 59.01(2)(B)(vii), notwithstanding Subsection (a),
and to the extent
necessary to protect the commission's ability to recover amounts
wrongfully obtained by the
owner of the property and associated damages and penalties to which the
commission is
otherwise authorized to be entitled by law. Authorizes the attorney
representing the state to, if
approved by the commission, sell the property and deliver to the
commission the proceeds from
the sale, minus costs attributable to the sale, if the forfeited property
consists of property other
than money or negotiable instruments. Requires the sale to be conducted in
a manner that is
reasonably expected to result in receiving the fair market value for the
property.
SECTION 2.132. STUDY. (a) Requires the Medicaid and Public Assistance
Fraud Oversight
Task Force, with the participation of TDH's bureau of vital statistics and
other agencies
designated by the comptroller of public accounts, to study procedures and
documentation requirements used by the state in confirming a person's
identity for purposes of establishing entitlement to Medicaid and other
benefits provided through health and human services programs.
(b) Requires, not later than December 1, 2004, the Medicaid and Public
Assistance Fraud
Oversight Task Force, with assistance from the agencies participating in
the study
required by Subsection (a) of this section, to submit a report to the
legislature containing
recommendations for improvements in the procedures and documentation
requirements
described by Subsection (a) of this section that would strengthen the
state's ability to
prevent fraud and abuse in the Medicaid program and other health and human
services
programs.
SECTION 2.133. EVALUATION OF MANAGED CARE PLANS. Requires HHSC, during
state fiscal years 2004 and 2005 and in accordance with federal policy, to
evaluate, as part of the processes of contract management and developing
payment and rate methodologies and amounts, the administrative cost of a
Medicaid managed care plan for a managed care organization, including a
health maintenance organization, primary care case management, and an
exclusive provider organization.
SECTION 2.134. STUDY: REVENUE ENHANCEMENT RELATED TO MEDICAID
VENDOR DRUG REBATE. (a) Creates a task force to study the prescription
drug rebate system established and operated under the medical assistance
program and other
related programs.
(b) Requires HHSC to establish a task force, composed of appropriate
legislators, state
agency personnel, and other appropriate personnel to study the
prescription drug rebate
system established and operated under the medical assistance program and
other related
programs.
(c) Requires the study to include certain information.
(d) Requires the study to be completed by December 1, 2004, and presented
to the governor and the presiding officers of each house, the House
Committee on Appropriations, and the Senate Finance Committee.
SECTION 2.135. LEGISLATIVE INTENT REGARDING PROVISION OF HEALTH AND
HUMAN SERVICE TRANSPORTATION THROUGH THE TEXAS DEPARTMENT OF
TRANSPORTATION. Sets forth legislative intent.
SECTION 2.136. (a) Provides that a change in law made by this article to
Section 242.047,
Health and Safety Code, that requires HHSC to accept an annual
accreditation review from the
Joint Commission on Accreditation of Health Organizations for a nursing
home in satisfaction of
the requirements for certification: applies only to a nursing home that
participates in the medical
assistance program under Chapter 32, Human Resources Code, before
September 1, 2003; and
may be implemented only as a pilot program.
(b) Provides that a pilot program operated in accordance with this section
expires
September 1, 2007.
SECTION 2.137. (a) Requires the TSBP to adopt the rules required by
Section 562.1085,
Occupations Code, as added by this Act, not later than December 1, 2003.
(b) Provides that, notwithstanding Section 562.1085, Occupations Code, as
added by this
Act, a pharmacy is not required to accept unused drugs from a health care
facility before
January 1, 2004.
SECTION 2.138. TRANSFER OF MEDICAL TRANSPORTATION PROGRAM. (a) Provides
that on September 1, 2004, or on an earlier date specified by HHSC,
certain actions will occur relating to the transfer to HHSC.
(b) Requires HHSC to take all action necessary to provide for the transfer
of the medical
transportation program to HHSC as soon as possible after the effective
date of this section
but not later than September 1, 2004.
SECTION 2.139. CONSOLIDATION OF CERTAIN DIVISIONS AND ACTIVITIES. (a)
Requires HHSC to consolidate the Medicaid post-payment third-party
recovery divisions or
activities of DHS, the Medicaid vendor drug program, and the state's
Medicaid claims
administrator with the Medicaid post-payment third-party recovery
function, not later than March
1, 2004.
(b) Requires HHSC to use HHSC's Medicaid post-payment third-party recovery
contractor for the consolidated division.
(c) Requires HHSC to update its computer system to facilitate the
consolidation.
SECTION 2.140. ABOLITION OF ADVISORY COMMITTEES. (a) Provides that,
notwithstanding any other provision of state law, each advisory committee,
as that term is
defined by Section 2110.001, Government Code, created before the effective
date of this section
that advises a health and human services agency is abolished on the
effective date of this section
unless the committee: is required by federal law; or advises an agency
with respect to
certification or licensing programs, the regulation of entities providing
health and human
services, or the implementation of a duty prescribed under this article,
as determined by the
commissioner of HHSC.
(b) Requires the commissioner of health and human services to certify
which advisory
committees are exempt from abolition under Subsection (a) of this section
and publish
that certification in the Texas Register.
(c) Requires an advisory committee that is created on or after the
effective date of this
section or that is exempt under Subsection (b) of this section from
abolition to make
recommendations to the executive director of the health and human services
agency the
advisory committee was created to advise and to the commissioner of health
and human
services to assist with eliminating or minimizing overlapping functions or
required duties
between the health and human services agencies or between those agencies
and HHSC.
(d) Provides that this section does not apply to the telemedicine advisory
committee established under Section 531.02172, Government Code, as added
by Chapters 661 and 959, Acts of the 77th Legislature, Regular Session,
2001, and that committee continues in existence.
SECTION 2.141. Authorizes community mental health centers to coordinate
with local
community health centers, federally qualified health centers (FQHC),
and/or disproportionate
share hospitals for the purpose of accessing local, state, and federal
programs that could result in
lower cost pharmaceuticals. Authorizes community mental health centers to
form a referral
relationship with community health centers, FQHC, disproportionate share
hospitals, and/or
other eligible entities for the purpose of obtaining federal 340B pricing
for pharmaceuticals.
Authorizes community mental health centers to form a referral relationship
with community
health centers, FQHC, disproportionate share hospitals, and/or other
eligible entities for the
purpose of taking advantage of 340B or other lower cost drug programs
regardless of any
statewide preferred drug list or vendor drug program which may be adopted.
SECTION 2.142. CHILD HEALTH PLAN PROGRAM WAIVER. Requires HHSC to request
and actively pursue any necessary waivers from a federal agency or any
other appropriate entity
to allow families enrolled in the state Medicaid program to opt into the
child health plan program
under Chapter 62, Health and Safety Code, while retaining the appropriate
federal match rate and
the child's entitlement to Medicaid coverage, not later than October 1,
2003. Requires the waiver
to, on at least an annual basis, allow families eligible for Medicaid who
have previously opted to
enroll their children in the child health plan program under Chapter 62,
Health and Safety Code,
to return those children to the Medicaid program.
SECTION 2.143. STATE CHILD HEALTH PLAN AMENDMENT. (a) Provides that in this
section, "group plan" means the group health benefit plan under the health
insurance premium
payment reimbursement program established under Section 62.059, Health and
Safety Code.
(b) Requires HHSC, as soon as possible after the effective date of this
section, to submit
for approval a plan amendment relating to the state child health plan
under 42 U.S.C.
Section 1397ff, as amended, as necessary to include the employers' share
of required
premiums for coverage of individuals enrolled in the group plan as
expenditures 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, for federal
match funding for
the child health plan program provided under Chapter 62, Health and Safety
Code.
SECTION 2.144. STATE MEDICAID PLAN AMENDMENT. (a) Provides that in this
section, "group plan" means the group health benefit plan under the health
insurance premium
payment reimbursement program for Medicaid recipients established under
Section 32.0422,
Human Resources Code.
(b) Requires HHSC, as soon as possible after the effective date of this
section, to submit
an amendment to the state Medicaid plan as necessary to allow this state
to include the
employers' share of required premiums for coverage of individuals enrolled
in the group
plan as expenditures for the purpose of determining this state's Medicaid
program
expenditures for federal match funding for the state Medicaid program.
SECTION 2.145. REPEAL. (a) Repealer: Sections 62.055(b) and (c) (relating
to Contracts for Implementation of Child Health Plan), 62.056 (Community
Outreach Campaign; Toll-Free Hotline), 62.057 (Regional Advisory
Committees),142.006(d), (e), and (f) (relating to License Issuance; Term),
142.009(i) (relating to Surveys; Consumer Complaints), 142.0176 (Certain
Agencies Excepted), 252.206(d) (relating to Quality Assurance Fund), and
252.207(b) (relating to Reimbursement of Facilities), Health and Safety
Code, and Sections 32.024(i) (relating to Authority and Scope of Program;
Eligibility) and 32.027(b) and (e) (relating to Selection of Provider of
Medical Assistance), Human Resources Code.
(b) Provides that an advisory committee established under Section 62.057,
Health and
Safety Code, is abolished on the effective date of this section.
SECTION 2.146. Provides that in the event of a conflict between a
provision of this Act and
another Act passed by the 78th Legislature, Regular Session, 2003, that
becomes law, this Act
prevails and controls regardless of the relative dates of enactment.
SECTION 2.147. FEDERAL AUTHORIZATION OR WAIVER. Authorizes a state agency
to
delay implementing a provision of this Act until a requested federal
waiver or authorization
necessary to implement that provision is granted.
SECTION 2.148. Requires any funds that are used by TxDOT to implement the
transportation
services provided in Sections 2.116, 2.117, 2.118, 2.119, 2.120, 2.121,
2.122, and 2.123 of this Act be accounted for and budgeted separately from
other funds appropriated to TxDOT for any
other public transportation program or budget strategy.
SECTION 2.149. EFFECTIVE DATE. Effective date: September 1, 2003, except
as otherwise
provided by this article.
LIST OF COMMITTEE AMENDMENTS
TECHNICAL AMENDMENT #1
Duties of Department of Aging and Disability Services
Amend proposed C.S.H.B. 2292 as follows:
(1) In Section 1.13A on page 58, line 16, strike "and"
(2) In Section 1.13A, on page 58, between lines 16 and 17, insert the
following language:
" (7) performing all licensing and enforcement activities related to
assisted living facilities under Chapter 247, Health and Safety Code;
(8) performing all licensing and enforcement activities related to
intermediate care facilities for persons with mental retardation under
Chapter 252, Health and Safety Code; and"
(3) In Section 1.13A, on page 58, on line 17, strike " (7) " and
substitute " (9) "
TECHNICAL AMENDMENT #2
Transfer of Duties to Department of Family and Protective Services
Amend proposed C.S.H.B. 2292 as follows:
(1) On page 67, line 9, strike Section 1.20;
(2) In Section 1.23, on page 75, line 6, strike "1.20";
(3) In Section 1.23, on page 75, lines 7-8, strike "the Department of
Family and Protective Services,"
TECHNICAL AMENDMENT #3
Purchasing Provisions Applicable to HHS Agencies
Amend C.S.H.B. 2292 by adding the following appropriately numbered
sections to read as follows:
SECTION _. Section 2177.0001(3), Government Code, is amended to read as
follows:
(3) "State agency" has the meaning assigned by Section 2054.003, except
that the term does not include a university system or institution of
higher education or an agency identified in Section 531.001(4).
SECTION ___. Section 2177.101(a), Government Code, is amended to read as
follows:
(a) This subchapter does not apply to procurements conducted by an agency
identified in Section 531.001(4) or to procurements for major construction
projects, as defined by the commission in consultation with the
department, such as procurements made under Chapter 223, Transportation
Code. In defining a major construction project, the commission shall base
its decision on whether the nature of the project, any related contract or
specifications, or other considerations are of a type that would make
electronic procurement inappropriate.
SECTION __. Section 2055.001(4), Government Code, is amended to read as
follows:
(3) "State agency" has the meaning assigned by Section 2054.003, except
that the term does not include a university system or institution of
higher education or an agency identified in Section 531.001(4).
SECTION __. Section 2055.002, Government Code, is amended to read as
follows:
2055.002. Applicability to Institutions of Higher Education or Health
and Human Services Agencies
(a) Except as provided by Subsection (b), the requirements of this
chapter regarding electronic government projects do not apply to
institutions of higher education or a health and human services agency
identified in Section 531.001(4), Government Code.
(b) Subject to approval by the office, an institution of higher education
or a health and human service agency may elect to participate regarding an
electronic government project of that institution or agency in the same
manner as a state agency under this chapter. If the institution or health
and human service agency makes this election and the office approves the
election, the institution or health and human service agency:
(1) shall comply with this chapter regarding that electronic government
project in the same manner as a state agency; and
(2) may not withdraw the project from management by the office unless the
office approves the withdrawal.
TECHNICAL AMENDMENT #4
CHIP Cost Sharing
Amend proposed C.S.H.B. 2292 as follows:
In Section 2.44, on page 136, line 12, add the following language between
"law" and ".":
"and applied to income levels in a manner that minimizes administrative
costs".
TECHNICAL AMENDMENT #5
90-day Waiting Period
Amend proposed C.S.H.B. 2292 as follows:
In Section 2.45, on page 138, strike lines 5-8 and substitute the
following:
" [(1)] extend for a period of 90 days after:
(i) the first day of the month in [last date on] which the applicant is
enrolled under the child health plan, if the date of enrollment is on or
before the 15th day of the month; or
(ii) the first day of the month after which the applicant is enrolled
under the child health plan, if the date of enrollment is after the 15th
day of the month [was covered under a health benefits plan; and]"
TECHNICAL AMENDMENT #6
Quality Standards for Privatization of State Schools
Amend proposed C.S.H.B. 2292 as follows:
(1) In Section 2.68, on page 162, line 5, strike "and"
(2) In Section 2.68, on page 162, between lines 5 and 6, insert the
following language:
" (3) the private service provider is required under the contract to
operate the school at a quality level at least equal to the quality level
achieved by the department when the department operated the school, as
measured by the school's most recent applicable ICF/MR survey; and"
(3) In Section 2.68, on page 162, line 6, strike " (3) " and substitute
" (4) "
TECHNICAL AMENDMENT #7
Department of Family and Protective Services
Amend proposed C.S.H.B. 2292 in Section 2.107 by changing all references
to the "Department of Protective Services" to read the "Department of
Protective and Regulatory Services" (page 208, lines 10-11, page 213,
lines 12, 20, and 24-25, and page 214, lines 9 and 14).
TECHNICAL AMENDMENT #8
Medically Needy
Amend proposed C.S.H.B. 2292 as follows:
(1) Add the following new section, appropriately numbered, to read as
follows:
SECTION____. Section 32.024 (i), Human Resources Code, is amended to
read as follows:
(i) The department in its adoption of rules may [shall] establish a
medically needy program that serves pregnant women, children, and
caretakers who have high medical expenses, subject to availability of
appropriated funds.
(2) In Section 2.145, on page 244, line 2, strike "32.024(i)".
TECHNICAL AMENDMENT #9
Correcting Chapter Reference
Amend proposed C.S.H.B. 2292 as follows:
(1) On page 7, line 27, following "with", insert "Government Code".
(2) On page 7, line 28, strike "2101" and insert "2102"
TECHNICAL AMENDMENT #13
PDL amendment
Amend proposed C.S.H.B. 2292 as follows:
(1) In Section 2.11, on page 88, line 27, strike "quarterly Medicaid" and
substitute "appropriate quarterly health and human services program"
(2) In Section 2.11, on page 89, line 2, insert "if necessary," between
"and" and "approved"
(3) In Section 2.13, on page 94, strike lines 4-5 and substitute the
following:
"for community mental health centers, state mental health hospitals, and
any other state program administered by the commission or a state health
and human services agency."
(4) In Section 2.14, page 96, strike line 2 and substitute the following:
"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"
(5) In Section 2.14, on page 96, line 10, between " illnesses " and " that
" strike " and "
(6) In Section 2.14, beginning on page 98, line 1, strike subsection (f)
and reletter subsequent subsections accordingly.
TECHNICAL AMENDMENT # 14
Prescribing practitioners
Amend proposed C.S.H.B. 2292, in SECTION 2.14 of the bill, amend Sec.
531.073 (a), Government Code (page 96, line 7, proposed committee
substitute) as follows:
After "physician" and before the period, insert "or prescribing
practitioner".
TECHNICAL AMENDMENT #15
Sunset Date for Premium Tax Exemption
Amend proposed C.S.H.B. 2292 as follows:
(1) In Section 2.108, on page 217, lines 1-2, strike subsection (c);
(2) In Section 2.109, on page 217, lines 25-26, strike subsection (c);
(1) In Section 2.110, on page 218, line 27 through page 219, line 1,
strike subsection (c);
COMMITTEE AMENDMENT #16
Amend C.S.H.B. No. 2292 as follows:
Section 32.028, Human Resources Code, is amended by amending subsection
(g) and adding Subsection (i) to read as follows:
(g) Subject to Subsection (i), the [The] Health and Human Services
Commission shall ensure that the rules governing the determination of
rates paid for nursing home services improve the quality of care by:
(1) providing a program offering incentives for increasing direct care
staff and direct care wages and benefits, but only to the extent that
appropriated funds are available after money is allocated to base rate
reimbursements as determined by the Health and Human Services Commission's
nursing facility rate setting methodologies; and
(2) if appropriated funds are available after money is allocated for
payment of incentive-based rates under Subdivision (1), providing
incentives that incorporate the use of a quality of care index, a customer
satisfaction index, and a resolved complaints index developed by the
commission.
(i) The Health and Human Services Commission shall ensure that rules
governing the incentives program described by Subsection (g)(1):
(1) provide that participation in the program by a nursing home is
voluntary;
(2) do not impose on a nursing home not participating in the program a
minimum spending requirement for direct care staff wages and benefits; and
(3) do not set a base rate for a nursing home participating in the
program that is more than the base rate for a nursing home participation
in the program.
COMMITTEE AMENDMENT #18
Amend the proposed substitute to H.B. No. 2292 by adding the following
appropriately numbered Section to Article 2 of the bill and renumbering
subsequent SECTIONS of the article accordingly:
SECTION 2.__. Subchapter A, Chapter 531, Government code, is amended by
adding Section 531.018 to read as follows:
Sec. 531.018. EMPLOYEE WELLNESS PROGRAM. (a) The commission and each
health and human services agency shall designate an individual as the
wellness coordinator for their respective agency. The wellness
coordinator may collaborate with other agencies and sources to provide
information and resources to employees thorugh bulletin boards and e-mail.
The employee wellness program may include:
(1) an agnecy wellness center staffed by a nurse
practitioner who provides employees with services such as blood pressure
monitoring and annual health assessments;
(2)ergonomic office equipment;
(3) nutrition education;
(4) smoking cessation programs; and
(b) A Health and human services agency with fewer than 100 employees may
join with the commission or a health and human services agency with 100
employees or more to create a program under this section and to share
resources under the program.
COMMITTEE AMENDMENT #19
Amend H.B. No. 2292 (House Engrossed Printing) by adding the following
appropriately numbered SECTION to article 2 of the bill and renumbering
subsequent SECTIONS of the article accordingly:
SECTION 2.___. (a) Subtitle E, Title 2, Health and Safety Code, is
amended by adding Chapter 112 to read as follows:
CHAPTER 112. BORDER HEALTH FOUNDATION
Sec. 112.001. DEFINITIONS. In the chapter:
(1) "Board of directors" means the board of
directors of the Border Health Foundation.
(2) "Foundation" means the Border Health Foundation.
Sec. 112.002. CREATION OF FOUNDATION. (a) The department shall establish
the Border Health Foundation as a nonprofit corporation that complies with
the Texas Non-Profit Corporation Act (Article 1396-1.01 et seq., Vernon's
Texas Civil Statutes), except as otherwise provided by this chapter, and
qualifies as an organizatioin exempt from federal income tax under Section
501 (c) (3), Internal Revenue Code of 1986, as amended.
(b) The department shall ensure that the foundation operates independetly
of any state agency or political subdivision of this state.
Sec. 112.003. POWERS AND DUTIES. (a) The foundation shall raise money
from other foundations, governmental entities, and other sources to
finance health programs in this state in areas adjacent to the border with
the United Mexican States.
(b) The foundation shall:
(1) identify and seek potential partners in the
private sector that will afford this state the opportunity to maintain or
increase the existing levels of financing of health programs and
activities;
(2) engage in outreach efforts to make the
existence of the office known to potential partners throughout this state;
and
(3) perform any other function necessary to carry
out the purposes of this section.
(c) The department shall review programs from all agencies under its
control to determine which projects should be available to received money
under Subsection (a).
(d) The foundation has the powers necessary and convenient to carry out
its duties.
Sec. 112.004 ADMINISTRATION. (a) The foundation is governed by a board of
five directors appointed by the Texas Board of Health from individuals
recommended by the commissioner.
(b) Members of the board of directors serve for staggered terms of six
years, with as near as possible to one-third of the member's terms
expiring every two years.
(c) Appointments to the board of directors shall be made without regard
to the race, color, disability, sex, religion, age, or national origin of
the appointees.
(d) The board of directors shall ensure that the foundation remains
eligible for an exemption from federal income tax under Section 501(a),
Internal Revenue Code of 1986, as amended, by being listed as an exempt
organization under Section 501 (c) (3) of that code, as amended.
Sec. 112.005. RESTRICTIONS ON BOARD APPOINTMENT, MEMBERSHIP, AND
EMPLOYMENT. (a) In this section, "Texas trade association" means a
cooperative and voluntarily joined association of business or professional
competitors in this state designed to assist its members and its industry
or profession in dealing with mutual business or professional problems and
in promoting their common interest.
(b) A person may not be a member of the board of directors and may not be
a foundation employee employed in a "bona fide executive, administrative,
or professional capacity," as that phrase is used for purposes of
establishing an exemption to the overtime provisions of the federal Fair
Labor Standards Act of 1938 (29 U.S.C. Section 201 et seq.), as amended,
if:
(1) the person is an officer, employee, or paid
consultant of a Texas trade association in the field of health care; or
(2) the person's spouse is an officer, manager,
or paid consultant of a Texas trade association in the field of health
care.
(c) A person may not be a member of the board of directors or act as the
general counsel to the board of directors or the foundation 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 foundation.
Sec. 112.006. REMOVAL OF BOARD MEMBER. (a) It is a ground for removal
from the board of directors that a member:
(1) is ineligible for membership under Section
112.005;
(2) cannot, because of illness or disability,
discharge the member's duties for a substantial part of the member's term;
or
(3) is absent from more than half of the
regularly scheduled board meetings that the member is eligible to attend
during a calendar year without an excuse approved by a majority vote of
the board of directors.
(b) The validity of an action of the board of directors is not affected
by the fact that it is taken when a ground for removal of a board member
exists.
(c) The foundation in its articles or bylaws shall establish the manner
in which a board member may be removed under this section
and may establish other grounds for removal of a member.
Sec. 112.007. VACANCY. A vacancy on the board of directors shall be
filled for the remainder of the unexpired term in the same manner as
provided in Section 112.004(a).
Sec. 112.008. OFFICERS. The board of directors shall elect from among its
members a presiding officer, an assistant presiding officer, and other
necessary officers. The presiding officer and assistant presiding officer
serve for a period of one year and may be reelected.
Sec. 112.009. MEETINGS. The board of directors may meet as often as
necessary, but shall meet at least twice a year.
Sec. 112.010. TAX EXEMPTION. All income, property, and other assets of
the foundation are exempt from taxation by this state and political
subdivisions of this state.
Sec. 112.011. MEMORANDUM OF UNDERSTANDING. The foundation and the
department shall enter into a memorandum of understanding that:
(1) requires the board of directors and
staff of the foundation to report to the commissioner and department;
(2) allows the department to provide staff
functions to the foundation; and
(3) outlines the financial contributions to
be made to the foundation from funds obtained from grants and other
sources.
Sec. 112.012. FUNDING. (a) The department, another agency of this state,
including an institution of higher education as defined by Section 61.003,
Education Code, or a political subdivision of this state may contract with
the foundation to finance, on behalf of the department, agency, or
political subdivision, health programs described by Section 112.003.
(b) The foundation may apply for and accept funds from the federal
government or any other public or private entity. The foundation or any
member of the foundation may also solicit and accept pledges, gifts, and
endowments from private sources on the foundation's behalf. The
foundation may only accept a pledge, gift, or endowment solicited under
this section that is consistent with the purposes of the foundation.
(c) The board of directors of the foundation shall manage and approve
disbursements of funds, pledges, gifts, and endowments that are the
property of the foundation.
(d) The board of directors of the foundation shall manage any capital
improvements constructed, owned, or leased by the foundation and any real
property acquired by the foundation.
Sec. 112.013. RECORDS. (a) The foundation shall maintain financial
records and reports independently from those of the department.
(b) The foundation shall comply with all filing requirements of the
secretary of state and the Internal Revenue Service.
Sec. 112.014. REPORT TO DEPARTMENT. Not later than the 60th day after the
last day of the fiscal year, the foundation shall submit to the department
a report itemizing all income and expenditures and describing all
activities of the foundation during the preceding fiscal year.
(b) The Border Health Foundation shall be created as required by this
section not later than June 1, 2004.