80R9721 KLA/KFF-F
 
  By: Nelson S.B. No. 10
 
 
 
   
 
 
A BILL TO BE ENTITLED
AN ACT
relating to the operation and financing of the medical assistance
program and other programs to provide health care benefits and
services to persons in this state.
       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
       SECTION 1.  (a) Subchapter B, Chapter 531, Government Code,
is amended by adding Sections 531.094, 531.0941, 531.097, and
531.0971 to read as follows:
       Sec. 531.094.  PILOT PROGRAM TO PROMOTE HEALTHY LIFESTYLES.
(a) The commission shall develop and implement a pilot program in
one region of this state under which Medicaid recipients are
provided incentives to lead healthy lifestyles, including through
participating in certain health-related programs or engaging in
certain health-conscious behaviors, thereby resulting in better
health outcomes for those recipients.
       (b)  Except as provided by Subsection (c), in implementing
the pilot program, the commission may provide:
             (1)  expanded health care benefits or value-added
services for Medicaid recipients who participate in certain
programs, such as specified weight loss or smoking cessation
programs;
             (2)  individual health rewards accounts that allow
Medicaid recipients who follow certain disease management
protocols to receive money deposits into the accounts that may be
used to purchase health-related items specified by the commission
that are not covered by Medicaid; and
             (3)  any other incentive the commission determines
would promote healthy lifestyles and improve health outcomes for
Medicaid recipients.
       (c)  The commission shall consider similar incentive
programs implemented in other states to determine the most
cost-effective measures to implement in the pilot program under
this section.
       (d)  Not later than December 1, 2010, the commission shall
submit a report to the legislature that:
             (1)  describes the operation of the pilot program;
             (2)  analyzes the effect of the incentives provided
under the pilot program on the health of program participants; and
             (3)  makes recommendations regarding the continuation
or expansion of the pilot program.
       (e)  This section expires September 1, 2011.
       Sec. 531.0941.  MEDICAID HEALTH SAVINGS ACCOUNT PILOT
PROGRAM. If the commission determines that it is feasible, the
commission shall develop and implement a Medicaid health savings
account pilot program that is consistent with federal law to:
             (1)  encourage health care cost awareness and
sensitivity; and
             (2)  promote appropriate utilization of Medicaid
services by recipients.
       Sec. 531.097.  TAILORED BENEFIT PACKAGES FOR CERTAIN
CATEGORIES OF THE MEDICAID POPULATION.  (a)  The executive
commissioner may seek a waiver under Section 1115 of the federal
Social Security Act (42 U.S.C. Section 1315) to develop and
implement tailored benefit packages designed to:
             (1)  provide Medicaid benefits that are customized to
meet the health care needs of recipients within defined categories
of the Medicaid population through a defined system of care;
             (2)  improve health outcomes for those recipients;
             (3)  improve those recipients' access to services;
             (4)  achieve cost containment and efficiency; and
             (5)  reduce the administrative complexity of
delivering Medicaid benefits.
       (b)  Except as provided by Subsection (c) and subject to the
terms of the waiver authorized by this section, the commission has
broad discretion to develop the tailored benefit packages under
this section and determine the respective categories of Medicaid
recipients to which the packages apply in a manner that preserves
recipients' access to necessary services and is consistent with
federal requirements.
       (c)  Each tailored benefit package developed under this
section must include:
             (1)  a basic set of benefits that are provided under all
tailored benefit packages; and
             (2)  to the extent applicable to the category of
Medicaid recipients to which the package applies:
                   (A)  a set of benefits customized to meet the
health care needs of recipients in that category; and
                   (B)  services to integrate the management of a
recipient's acute and long-term care needs, to the extent feasible.
       (d)  A tailored benefit package developed under this section
may include any service available under the state Medicaid plan or
under any federal Medicaid waiver, including any preventive health
or wellness service.
       (e)  In developing the tailored benefit packages, the
commission shall consider similar benefit packages established in
other states as a guide.
       (f)  The executive commissioner, by rule, shall define each
category of recipients to which a tailored benefit package applies
and a mechanism for appropriately placing recipients in specific
categories.  Recipient populations to which a package applies may
include:
             (1)  persons with disabilities or special health needs;
             (2)  elderly persons;
             (3)  children; and
             (4)  working-age parents and caretaker relatives.
       Sec. 531.0971.  TAILORED BENEFIT PACKAGES FOR NON-MEDICAID
POPULATIONS. (a) The commission shall identify state or federal
non-Medicaid programs that provide health care services to persons
whose health care needs could be met by providing customized
benefits through a system of care that is used under a
Medicaid-tailored benefit package implemented under Section
531.097.
       (b)  If the commission determines that it is feasible and to
the extent permitted by federal and state law, the commission
shall:
             (1)  provide the health care services for persons
identified under Subsection (a) through the applicable
Medicaid-tailored benefit package; and
             (2)  if appropriate or necessary to provide the
services as required by Subdivision (1), develop and implement a
system of blended funding methodologies to provide the services in
that manner.
       (b)  Not later than September 1, 2008, the Health and Human
Services Commission shall implement the pilot program under Section
531.094, Government Code, as added by this section.
       SECTION 2.  (a) Subchapter C, Chapter 531, Government Code,
is amended by adding Section 531.1112 to read as follows:
       Sec. 531.1112.  STUDY CONCERNING INCREASED USE OF TECHNOLOGY
TO STRENGTHEN FRAUD DETECTION AND DETERRENCE; IMPLEMENTATION.  (a)
The commission and the commission's office of inspector general
shall jointly study the feasibility of increasing the use of
technology to strengthen the detection and deterrence of fraud in
the state Medicaid program.  The study must include the
determination of the feasibility of using technology to verify a
person's citizenship and eligibility for coverage.
       (b)  The commission shall implement any methods the
commission and the commission's office of inspector general
determine are effective at strengthening fraud detection and
deterrence.
       (b)  Not later than December 1, 2008, the Health and Human
Services Commission shall submit to the legislature a report
detailing the findings of the study required by Section 531.1112,
Government Code, as added by this section.  The report must include
a description of any method described by Section 531.1112(b),
Government Code, as added by this section, that the commission has
implemented or intends to implement.
       SECTION 3.  (a)  Chapter 531, Government Code, is amended by
adding Subchapter N to read as follows:
SUBCHAPTER N. TEXAS HEALTH OPPORTUNITY POOL
       Sec. 531.501.  DIRECTION TO OBTAIN FEDERAL WAIVER FOR POOLED
FUNDS. (a) The executive commissioner may seek a waiver under
Section 1115 of the federal Social Security Act (42 U.S.C. Section
1315) to the state Medicaid plan to allow the commission to more
efficiently and effectively use federal money paid to this state
under various programs to defray costs associated with providing
uncompensated health care in this state by:
             (1)  depositing that federal money and, to the extent
necessary, state money, into a pooled fund established in the state
treasury outside the general revenue fund; and
             (2)  using the money for purposes consistent with this
subchapter.
       (b)  The federal money the executive commissioner may seek
approval to pool includes:
             (1)  money provided under the disproportionate share
hospitals and upper payment limit supplemental payment programs;
             (2)  money provided by the federal government in lieu
of some or all of the payments under those programs;
             (3)  any combination of funds described by Subdivisions
(1) and (2); and
             (4)  any other federal money available for that
purpose.
       (c)  The terms of a waiver approved under this section must:
             (1)  include safeguards to ensure that the total amount
of federal money in the pooled fund and any federal money provided
under the disproportionate share hospitals and upper payment limit
supplemental payment programs that is not included in the pooled
fund is, for a particular state fiscal year, at least equal to the
amount provided to this state under those supplemental payment
programs during state fiscal year 2007;
             (2)  allow for the development by this state of a
methodology for allocating money in the pooled fund to:
                   (A)  offset, in part, the uncompensated health
care costs incurred by hospitals; and
                   (B)  reduce the number of uninsured persons in
this state; and
             (3)  if possible, include an annual adjustment to the
amount of upper payment limit supplemental payment program money
provided to this state to account for inflation and population
growth.
       (d)  The executive commissioner shall seek to obtain in a
waiver under this section maximum flexibility with respect to using
the money in the pooled fund for purposes consistent with this
subchapter.
       Sec. 531.502.  ESTABLISHMENT OF TEXAS HEALTH OPPORTUNITY
POOL. Subject to approval of the waiver authorized by Section
531.501, the Texas health opportunity pool is established in
accordance with the terms of that waiver as an account in the state
treasury outside the general revenue fund. Money in the pool may be
used only for purposes consistent with this subchapter and the
terms of the waiver.
       Sec. 531.503.  USE OF TEXAS HEALTH OPPORTUNITY POOL IN
GENERAL; RULES FOR ALLOCATION. (a)  Except as otherwise provided by
the terms of a waiver authorized by Section 531.501, money in the
Texas health opportunity pool may be used:
             (1)  subject to Section 531.504, to provide
reimbursements to health care providers that:
                   (A)  are based on the providers' costs related to
providing uncompensated care; and
                   (B)  compensate the providers for at least a
portion of those costs;
             (2)  to reduce the number of persons in this state who
do not have health benefits coverage;
             (3)  to reduce the need for uncompensated health care
provided by hospitals in this state; and
             (4)  for any other purpose specified by this subchapter
or the waiver.
       (b)  On approval of the waiver, the executive commissioner by
rule shall develop a methodology for allocating money in the pool.  
The methodology must be consistent with the terms of the waiver.
       Sec. 531.504.  REIMBURSEMENTS FOR UNCOMPENSATED HEALTH CARE
COSTS. (a)  Except as otherwise provided by the terms of a waiver
authorized by Section 531.501 and subject to Subsections (b) and
(c), money in the Texas health opportunity pool may be allocated to
hospitals and counties in this state to defray the costs of
providing uncompensated health care in this state.
       (b)  To be eligible for money from the pool under this
section, a hospital or county must use a portion of the money to
implement strategies that will reduce the need for uncompensated
inpatient and outpatient care, including care provided in a
hospital emergency room. Strategies that may be implemented by a
county or hospital, as applicable, include:
             (1)  fostering improved access for patients to primary
care systems or other programs that offer those patients medical
homes, including the following programs:
                   (A)  three share or multiple share programs;
                   (B)  programs to provide premium subsidies for
health benefits coverage; and
                   (C)  other programs to increase access to health
benefits coverage; and
             (2)  creating health care systems efficiencies, such as
using electronic medical records systems.
       (c)  The allocation methodology adopted by the executive
commissioner under Section 531.503(b) must specify the percentage
of the money from the pool allocated to a hospital or county that
the hospital or county must use for strategies described by
Subsection (b).
       Sec. 531.505.  INCREASING ACCESS TO HEALTH BENEFITS
COVERAGE. (a) Except as otherwise provided by the terms of a
waiver authorized by Section 531.501, money in the Texas health
opportunity pool that is available to reduce the number of persons
in this state who do not have health benefits coverage or to reduce
the need for uncompensated health care provided by hospitals in
this state may be used for purposes relating to increasing access to
health benefits coverage for low-income persons, including:
             (1)  providing premium payment assistance to those
persons through a premium payment assistance program developed
under this section; and
             (2)  making contributions to health savings accounts
for those persons.
       (b)  The commission and the Texas Department of Insurance
shall jointly develop a premium payment assistance program designed
to assist persons described by Subsection (a) in obtaining and
maintaining health benefits coverage.  The program may provide
assistance in the form of payments for all or part of the premiums
for that coverage.  In developing the program, the executive
commissioner shall adopt rules establishing:
             (1)  eligibility criteria for the program;
             (2)  the amount of premium payment assistance that will
be provided under the program; and
             (3)  the process by which that assistance will be paid.
       (c)  The commission shall implement the premium payment
assistance program developed under Subsection (b), subject to
appropriations for that purpose.
       Sec. 531.506.  INFRASTRUCTURE IMPROVEMENTS.  (a)  Except as
otherwise provided by the terms of a waiver authorized by Section
531.501 and subject to Subsection (c), money in the Texas health
opportunity pool may be used for purposes related to developing and
implementing initiatives to improve the infrastructure of local
provider networks that provide services to Medicaid recipients and
low-income uninsured persons in this state.
       (b)  Infrastructure improvements under this section may
include developing and implementing a system for maintaining
medical records in an electronic format.
       (c)  Not more than 10 percent of the total amount of the money
in the pool used in a state fiscal year for purposes other than
providing reimbursements to hospitals for uncompensated health
care may be used for infrastructure improvements described by
Subsection (b).
       (b)  The Health and Human Services Commission shall:
             (1)  identify health care related state and local funds
and program expenditures that are not, on the effective date of this
Act, being matched with federal money; and
             (2)  explore the feasibility of certifying or otherwise
using those funds and expenditures as state expenditures for which
this state may receive federal payments under the disproportionate
share hospitals and upper payment limit supplemental payment
programs instead of using money received by this state through
intergovernmental transfers for that purpose.
       SECTION 4.  (a) Chapter 531, Government Code, is amended by
adding Subchapter O to read as follows:
SUBCHAPTER O. UNCOMPENSATED HOSPITAL CARE
       Sec. 531.551.  UNCOMPENSATED HOSPITAL CARE REPORTING AND
ANALYSIS. (a)  The executive commissioner shall adopt rules
providing for:
             (1)  a standard definition of "uncompensated hospital
care";
             (2)  a methodology to be used by hospitals in this state
to compute the cost of that care that incorporates the standard set
of adjustments described by Section 531.552(g)(4); and
             (3)  procedures to be used by those hospitals to report
the cost of that care to the commission and to analyze that cost.
       (b)  The rules adopted by the executive commissioner under
Subsection (a)(3) may provide for procedures by which the
commission may periodically verify the completeness and accuracy of
the information reported by hospitals.
       Sec. 531.552.  WORK GROUP ON UNCOMPENSATED HOSPITAL
CARE.  (a) In this section, "work group" means the work group on
uncompensated hospital care.
       (b)  The executive commissioner shall establish the work
group on uncompensated hospital care to assist the executive
commissioner in developing rules required by Section 531.551 by
performing the functions described by Subsection (g).
       (c)  The executive commissioner shall determine the number
of members of the work group. The executive commissioner shall
ensure that the work group includes representatives from the office
of the attorney general and the hospital industry. A member of the
work group serves at the will of the executive commissioner.
       (d)  The executive commissioner shall designate a member of
the work group to serve as presiding officer. The members of the
work group shall elect any other necessary officers.
       (e)  The work group shall meet at the call of the executive
commissioner.
       (f)  A member of the work group may not receive compensation
for serving on the work group but is entitled to reimbursement for
travel expenses incurred by the member while conducting the
business of the work group as provided by the General
Appropriations Act.
       (g)  The work group shall study and advise the executive
commissioner in:
             (1)  identifying the number of different reports
required to be submitted to the state that address uncompensated
hospital care, care for low-income uninsured persons in this state,
or both;
             (2)  standardizing the definitions used to determine
uncompensated hospital care for purposes of those reports;
             (3)  improving the tracking of hospital charges, costs,
and adjustments as those charges, costs, and adjustments relate to
identifying uncompensated hospital care and maintaining a
hospital's tax-exempt status;
             (4)  developing and applying a standard set of
adjustments to a hospital's initial computation of the cost of
uncompensated hospital care that account for all funding streams
that:
                   (A)  are not patient-specific; and
                   (B)  are used to offset the hospital's initially
computed amount of uncompensated care;
             (5)  developing a standard and comprehensive center for
data analysis and reporting with respect to uncompensated hospital
care; and
             (6)  analyzing the effect of the standardization of the
definition of uncompensated hospital care and the computation of
its cost, as determined in accordance with the rules adopted by the
executive commissioner, on the laws of this state, and analyzing
potential legislation to incorporate the changes made by the
standardization.
       (b)  The executive commissioner of the Health and Human
Services Commission shall:
             (1)  establish the work group on uncompensated hospital
care required by Section 531.552, Government Code, as added by this
section, not later than October 1, 2007; and
             (2)  adopt the rules required by Section 531.551,
Government Code, as added by this section, not later than March 1,
2008.
       (c)  The executive commissioner of the Health and Human
Services Commission shall review the methodology used under the
Medicaid disproportionate share hospitals supplemental payment
program to compute low-income utilization costs to ensure that
standardized adjustments to uncompensated care costs described by
Section 531.552(g)(4), Government Code, as added by this Act, and
adopted by the executive commissioner are consistent with that
methodology.
       SECTION 5.  (a)  Subchapter A, Chapter 533, Government Code,
is amended by adding Section 533.019 to read as follows:
       Sec. 533.019.  VALUE-ADDED SERVICES. The commission shall
actively encourage managed care organizations that contract with
the commission to offer benefits, including health care services or
benefits or other types of services, that:
             (1)  are in addition to the services ordinarily covered
by the managed care plan offered by the managed care organization;
and
             (2)  have the potential to improve the health status of
enrollees in the plan.
       (b)  The changes in law made by Section 533.019, Government
Code, as added by this Act, apply to a contract between the Health
and Human Services Commission and a managed care organization under
Chapter 533, Government Code, that is entered into or renewed on or
after the effective date of this section.  The commission shall seek
to amend contracts entered into with managed care organizations
under that chapter before the effective date of this Act to
authorize those managed care organizations to offer value-added
services to enrollees in accordance with Section 533.019,
Government Code, as added by this section.
       SECTION 6.  Section 32.0422, Human Resources Code, is
amended to read as follows:
       Sec. 32.0422.  HEALTH INSURANCE PREMIUM PAYMENT
REIMBURSEMENT PROGRAM FOR MEDICAL ASSISTANCE RECIPIENTS. (a) In
this section:
             (1)  "Commission" ["Department"] means the Health and
Human Services Commission [Texas Department of Health].
             (2)  "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
             (3)  "Group health benefit plan" means a plan described
by Section 1207.001, Insurance Code.
       (b)  The commission [department] shall identify individuals,
otherwise entitled to medical assistance, who are eligible to
enroll in a group health benefit plan, but are not eligible for the
medical assistance opt-out program if that program is implemented
under Section 32.04221. The commission [department] must include
individuals eligible for or receiving health care services under a
Medicaid managed care delivery system.
       (b-1)  To assist the commission in identifying individuals
described by Subsection (b):
             (1)  the commission shall include on an application for
medical assistance and on a form for recertification of a
recipient's eligibility for medical assistance:
                   (A)  an inquiry regarding whether the applicant or
recipient, as applicable, is eligible to enroll in a group health
benefit plan; and
                   (B)  a statement informing the applicant or
recipient, as applicable, that reimbursements for required
premiums and cost-sharing obligations under the group health
benefit plan may be available to the applicant or recipient; and
             (2)  not later than the 15th day of each month, the
office of the attorney general shall provide to the commission the
name, address, and social security number of each newly hired
employee reported to the state directory of new hires operated
under Chapter 234, Family Code, during the previous calendar month.
       (c)  The commission [department] shall require an individual
requesting medical assistance or a recipient, during the
recipient's eligibility recertification review, to provide
information as necessary relating to any [the availability of a]
group health benefit plan that is available to the individual or
recipient through an employer of the individual or recipient  or an
employer of the individual's or recipient's spouse or parent to
assist the commission in making the determination required by
Subsection (d).
       (d)  For an individual identified under Subsection (b), the
commission [department] shall determine whether it is
cost-effective to enroll the individual in the group health benefit
plan under this section.
       (e)  If the commission [department] determines that it is
cost-effective to enroll the individual in the group health benefit
plan, the commission [department] shall:
             (1)  require the individual to apply to enroll in the
group health benefit plan as a condition for eligibility under the
medical assistance program; and
             (2)  provide written notice to the issuer of the group
health benefit plan in accordance with Chapter 1207, Insurance
Code.
       (e-1)  This subsection applies only to an individual who is
identified under Subsection (b) as being eligible to enroll in a
group health benefit plan offered by the individual's employer. If
the commission determines under Subsection (d) that enrolling the
individual in the group health benefit plan is not cost-effective,
but the individual prefers to enroll in that plan instead of
receiving benefits and services under the medical assistance
program, the commission, if authorized by a waiver obtained under
federal law, shall:
             (1)  allow the individual to enroll in the plan;
             (2)  consider that individual to be a recipient of
medical assistance; and
             (3)  provide written notice to the issuer of the group
health benefit plan in accordance with Chapter 1207, Insurance
Code.
       (f)  Except as provided by Subsection (f-1), the commission
[The department] shall provide for payment of:
             (1)  the employee's share of required premiums for
coverage of an individual enrolled in the group health benefit
plan; and
             (2)  any deductible, copayment, coinsurance, or other
cost-sharing obligation imposed on the enrolled individual for an
item or service otherwise covered under the medical assistance
program.
       (f-1)  For an individual described by Subsection (e-1) who
enrolls in a group health benefit plan, the commission shall
provide for payment of the employee's share of the required
premiums, except that if the employee's share of the required
premiums exceeds the Medicaid premium rate for the individual, as
determined by the executive commissioner, the individual shall pay
the difference between the required premiums and the Medicaid
premium rate. In addition, subject to federal law, the individual
shall pay all deductibles, copayments, coinsurance, and other
cost-sharing obligations imposed on the individual under the group
health benefit plan.
       (g)  A payment made by the commission [department] under
Subsection (f) or (f-1) is considered to be a payment for medical
assistance.
       (h)  A payment of a premium for an individual who is a member
of the family of an individual enrolled in a group health benefit
plan under Subsection (e) [this section] and who is not eligible for
medical assistance is considered to be a payment for medical
assistance for an eligible individual if:
             (1)  enrollment of the family members who are eligible
for medical assistance is not possible under the plan without also
enrolling members who are not eligible; and
             (2)  the commission [department] determines it to be
cost-effective.
       (i)  A payment of any deductible, copayment, coinsurance, or
other cost-sharing obligation of a family member who is enrolled in
a group health benefit plan in accordance with Subsection (h) and
who is not eligible for medical assistance:
             (1)  may not be paid under this chapter; and
             (2)  is not considered to be a payment for medical
assistance for an eligible individual.
       (i-1)  The commission shall make every effort to expedite
payments made under this section, including by ensuring that those
payments are made through electronic transfers of money to the
recipient's account at a financial institution, if possible. In
lieu of reimbursing the individual enrolled in the group health
benefit plan for required premium or cost-sharing payments made by
the individual, the commission may, if feasible:
             (1)  make payments under this section for required
premiums directly to the employer providing the group health
benefit plan in which an individual is enrolled; or
             (2)  make payments under this section for required
premiums and cost-sharing obligations directly to the group health
benefit plan issuer.
       (j)  The commission [department] shall treat coverage under
the group health benefit plan as a third party liability to the
program. Enrollment of an individual in a group health benefit plan
under this section does not affect the individual's eligibility for
medical assistance benefits, except that the state is entitled to
payment under Sections 32.033 and 32.038.
       (k)  The commission [department] may not require or permit an
individual who is enrolled in a group health benefit plan under this
section to participate in the Medicaid managed care program under
Chapter 533, Government Code, or a Medicaid managed care
demonstration project under Section 32.041.
       (l)  [The Texas Department of Human Services shall provide
information and otherwise cooperate with the department as
necessary to ensure the enrollment of eligible individuals in the
group health benefit plan under this section.
       [(n)]  The executive commissioner [department] shall adopt
rules as necessary to implement this section.
       SECTION 7.  Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.04221 to read as follows:
       Sec. 32.04221.  MEDICAL ASSISTANCE OPT-OUT PROGRAM. (a) In
this section:
             (1)  "Commission" means the Health and Human Services
Commission.
             (2)  "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
             (3)  "Group health benefit plan" means a plan described
by Section 1207.001, Insurance Code.
       (b)  The commission shall seek a waiver from an appropriate
federal agency under which a person who is eligible for or is a
recipient of medical assistance and who is a member of a population
of recipients specified in the waiver may choose to opt out of
receiving services under the medical assistance program and instead
enroll in a group health benefit plan offered by an employer.
       (c)  The commission shall ensure that participation by a
person in the opt-out program is on a voluntary basis, and the
commission may not require any person to opt out of receiving
medical assistance services.
       (d)  Consistent with the terms of the waiver, for a
participant in the opt-out program who enrolls in a group health
benefit plan offered by an employer, the commission shall provide
for payment of the employee's share of the required premiums,
except that if the employee's share of the required premiums
exceeds the Medicaid premium rate for the participant, as
determined by the executive commissioner, the participant shall pay
the difference between the required premiums and the Medicaid
premium rate. In addition, the participant shall pay all
deductibles, copayments, coinsurance, and other cost-sharing
obligations imposed on the participant under the group health
benefit plan.
       (e)  Except as limited by the terms of the waiver, a
participant in the opt-out program is limited to the health
benefits coverage provided under the health benefits plan in which
the participant enrolls. The participant may not receive any
benefits or services under the medical assistance program other
than the premium payment as provided by Subsection (d).
       (f)  A person who is eligible for or is a recipient of medical
assistance and who is a member of a population of recipients who are
eligible for the opt-out program, as determined under the terms of
the waiver, is not eligible to participate in the health insurance
premium payment assistance program under Section 32.0422.
       SECTION 8.  Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0641 to read as follows:
       Sec. 32.0641.  COST SHARING FOR CERTAIN HIGH-COST MEDICAL
SERVICES.  (a)  If the department determines that it is feasible and
cost-effective, and to the extent permitted under Title XIX, Social
Security Act (42 U.S.C. Section 1396 et seq.) and any other
applicable law or regulation or under a federal waiver or other
authorization, the executive commissioner of the Health and Human
Services Commission shall adopt cost-sharing provisions that
require a recipient who chooses a high-cost medical service when a
medically acceptable, lower-cost medical service is available to
pay a copayment or premium payment for the high-cost medical
service.
       (b)  A medical service is considered a high-cost medical
service for purposes of this section if the service is provided
through a hospital emergency room. The executive commissioner by
rule shall determine other medical services that are high-cost
medical services for purposes of this section.
       SECTION 9.  (a)  The heading to Subtitle C, Title 2, Health
and Safety Code, is amended to read as follows:
SUBTITLE C.  PROGRAMS PROVIDING [INDIGENT] HEALTH CARE BENEFITS AND
SERVICES
       (b)  Subtitle C, Title 2, Health and Safety Code, is amended
by adding Chapter 76 to read as follows:
CHAPTER 76. MULTIPLE SHARE PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
       Sec. 76.001.  DEFINITIONS. In this chapter:
             (1)  "Commission" means the Health and Human Services
Commission.
             (2)  "Employee" means an individual who is employed by
an employer for compensation. The term includes a partner of a
partnership and the proprietor of a sole proprietorship.
             (3)  "Employer" means a person who employs one or more
employees.
             (4)  "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
             (5)  "Multiple share program" means an
employer-sponsored commercial insurance product or noninsurance
health benefit plan funded by a combination of:
                   (A)  employer contributions;
                   (B)  employee cost sharing; and
                   (C)  public or philanthropic funds.
             (6)  "Partnering entity" means a local entity that
partners with the commission to obtain funding for a multiple share
program.
             (7)  "Public share" means the portion of the cost of a
multiple share program comprised of public funds.
[Sections 76.002-76.050 reserved for expansion]
SUBCHAPTER B. AUTHORITY OF COMMISSION; METHODS OF FUNDING
       Sec. 76.051.  MULTIPLE SHARE PROGRAM.  A local entity may
propose a multiple share program to the commission and may, subject
to rules adopted under Section 76.103, act as a partnering entity.
       Sec. 76.052.  FUNDING. The commission may seek a waiver from
the Centers for Medicare and Medicaid Services or another
appropriate federal agency to use Medicaid or child health plan
program funds to finance the public share of a multiple share
program.  The commission may cooperate with a partnering entity to
finance the public share.
       Sec. 76.053.  AUTHORITY TO DETERMINE SCOPE. The commission
may determine if a multiple share program proposed by a partnering
entity should be local, regional, or statewide in scope. The
commission shall base this determination on:
             (1)  appropriate methods to meet the needs of the
uninsured community; and
             (2)  federal guidance.
       Sec. 76.054.  METHOD OF FINANCE. If the legislature does not
appropriate sufficient money from the general revenue to fund a
multiple share program, a partnering entity may use the following
types of funding to maximize this state's receipt of available
federal matching funds provided through Medicaid and the child
health plan:
             (1)  local funds made available to this state through
intergovernmental transfers from local governments; and
             (2)  certified public expenditures.
[Sections 76.055-76.100 reserved for expansion]
SUBCHAPTER C. COST OF PROGRAM; CONTRIBUTION OF SHARES
       Sec. 76.101.  CONTRIBUTION OF SHARES. A multiple share
program may require that:
             (1)  each participating employer contribute at least
one-third of the cost of coverage; and
             (2)  this state or a political subdivision of this
state contribute not more than one-third of the cost of coverage.
       Sec. 76.102.  COST SHARING. Subject to applicable federal
law, an employee who participates in a multiple share program may be
required to pay:
             (1)  a share of the premium;
             (2)  copayments;
             (3)  coinsurance; and
             (4)  deductibles.
       Sec. 76.103.  STANDARDS AND PROCEDURES. The executive
commissioner by rule shall:
             (1)  define the types of local entities that may be
partnering entities;
             (2)  determine eligibility criteria for participating
employers and employees;
             (3)  determine a minimum benefit package for multiple
share programs that offer noninsurance health benefit plans;
             (4)  determine methods for limiting substitution of
coverage in multiple share programs of partnering entities;
             (5)  determine methods for limiting adverse selection
in multiple share programs of partnering entities; and
             (6)  determine how a multiple share program participant
may continue program coverage if the participant leaves the
employment of a participating employer or becomes ineligible due to
income.
       (c)  Not later than January 1, 2008, the executive
commissioner of the Health and Human Services Commission shall
adopt rules and procedures necessary to implement the multiple
share program created by Chapter 76, Health and Safety Code, as
added by this section.  In adopting the rules and procedures, the
executive commissioner may consult with the Texas Department of
Insurance.
       (d)  This section takes effect immediately if this Act
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for this section to
have immediate effect, this section takes effect September 1, 2007.
       SECTION 10.  (a)  In this section, "committee" means the
committee on health and long-term care insurance incentives.
       (b)  The committee on health and long-term care insurance
incentives is established to study and develop recommendations
regarding methods by which this state may reduce the need for
residents of this state to rely on the Medicaid program by providing
incentives for employers to provide health insurance, long-term
care insurance, or both, to their employees.
       (c)  The committee on health and long-term care insurance
incentives is composed of:
             (1)  the presiding officers of:
                   (A)  the Senate Health and Human Services
Committee;
                   (B)  the House Committee on Public Health;
                   (C)  the Senate State Affairs Committee; and
                   (D)  the House Committee on Insurance;
             (2)  three public members, appointed by the governor,
who collectively represent the diversity of businesses in this
state, including diversity with respect to:
                   (A)  the geographic regions in which those
businesses are located;
                   (B)  the types of industries in which those
businesses are engaged; and
                   (C)  the sizes of those businesses, as determined
by number of employees; and
             (3)  the following ex officio members:
                   (A)  the comptroller;
                   (B)  the commissioner of insurance; and
                   (C)  the executive commissioner of the Health and
Human Services Commission.
       (d)  The committee shall elect a presiding officer from the
committee members and shall meet at the call of the presiding
officer.
       (e)  The committee shall study and develop recommendations
regarding incentives this state may provide to employers to
encourage those employers to provide health insurance, long-term
care insurance, or both, to employees who would otherwise rely on
the Medicaid program to meet their health and long-term care needs.
In conducting the study, the committee shall:
             (1)  examine the feasibility and determine the cost of
providing incentives through:
                   (A)  the franchise tax under Chapter 171, Tax
Code, including allowing exclusions from an employer's total
revenue of insurance premiums paid for employees, regardless of
whether the employer chooses under Section 171.101(a)(1)(B)(ii),
Tax Code, as effective January 1, 2008, to subtract cost of goods
sold or compensation for purposes of determining the employer's
taxable margin;
                   (B)  deductions from or refunds of other taxes
imposed on the employer; and
                   (C)  any other means, as determined by the
committee; and
             (2)  for each incentive the committee examines under
Subdivision (1) of this subsection, determine the impact that
implementing the incentive would have on reducing the number of
individuals in this state who do not have private health or
long-term care insurance coverage, including individuals who are
Medicaid recipients.
       (f)  Not later than September 1, 2008, the committee shall
submit to the Senate Health and Human Services Committee, the House
Committee on Public Health, the Senate State Affairs Committee, and
the House Committee on Insurance a report regarding the results of
the study required by this section. The report must include a
detailed description of each incentive the committee examined and
determined is feasible and, for each of those incentives, specify:
             (1)  the anticipated cost associated with providing
that incentive;
             (2)  any statutory changes needed to implement the
incentive; and
             (3)  the impact that implementing the incentive would
have on reducing:
                   (A)  the number of individuals in this state who
do not have private health or long-term care insurance coverage;
and
                   (B)  the number of individuals in this state who
are Medicaid recipients.
       SECTION 11.  (a) The Health and Human Services Commission
shall conduct a study regarding the feasibility and
cost-effectiveness of developing and implementing an integrated
Medicaid managed care model designed to improve the management of
care provided to Medicaid recipients who are aging, blind, or
disabled or have chronic health care needs and are not enrolled in a
managed care plan offered under a capitated Medicaid managed care
model, including recipients who reside in:
             (1)  rural areas of this state; or
             (2)  urban or surrounding areas in which the Medicaid
Star + Plus program or another capitated Medicaid managed care
model is not available.
       (b)  Not later than September 1, 2008, the commission shall
submit a report regarding the results of the study to the standing
committees of the senate and house of representatives having
primary jurisdiction over the Medicaid program.
       SECTION 12.  If before implementing any provision of this
Act a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
       SECTION 13.  Except as otherwise provided by this Act, this
Act takes effect September 1, 2007.