S.B. No. 8
 
 
 
 
AN ACT
  relating to the provision and delivery of certain health and human
  services in this state, including the provision of those services
  through the Medicaid program and the prevention of fraud, waste,
  and abuse in that program and other programs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 531, Government Code, is
  amended by adding Section 531.0082 to read as follows:
         Sec. 531.0082.  DATA ANALYSIS UNIT.  (a)  The executive
  commissioner shall establish a data analysis unit within the
  commission to establish, employ, and oversee data analysis
  processes designed to:
               (1)  improve contract management;
               (2)  detect data trends; and
               (3)  identify anomalies relating to service
  utilization, providers, payment methodologies, and compliance with
  requirements in Medicaid and child health plan program managed care
  and fee-for-service contracts.
         (b)  The commission shall assign staff to the data analysis
  unit who perform duties only in relation to the unit.
         (c)  The data analysis unit shall use all available data and
  tools for data analysis when establishing, employing, and
  overseeing data analysis processes under this section.
         (d)  Not later than the 30th day following the end of each
  calendar quarter, the data analysis unit shall provide an update on
  the unit's activities and findings to the governor, the lieutenant
  governor, the speaker of the house of representatives, the chair of
  the Senate Finance Committee, the chair of the House Appropriations
  Committee, and the chairs of the standing committees of the senate
  and house of representatives having jurisdiction over the Medicaid
  program.
  SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02115 to read as follows:
         Sec. 531.02115.  MARKETING ACTIVITIES BY PROVIDERS
  PARTICIPATING IN MEDICAID OR CHILD HEALTH PLAN PROGRAM.  (a)  A
  provider participating in the Medicaid or child health plan
  program, including a provider participating in the network of a
  managed care organization that contracts with the commission to
  provide services under the Medicaid or child health plan program,
  may not engage in any marketing activity, including any
  dissemination of material or other attempt to communicate, that:
               (1)  involves unsolicited personal contact, including
  by door-to-door solicitation, solicitation at a child-care
  facility or other type of facility, direct mail, or telephone, with
  a Medicaid client or a parent whose child is enrolled in the
  Medicaid or child health plan program;
               (2)  is directed at the client or parent solely because
  the client or the parent's child is receiving benefits under the
  Medicaid or child health plan program; and
               (3)  is intended to influence the client's or parent's
  choice of provider.
         (b)  In addition to the requirements of Subsection (a), a
  provider participating in the network of a managed care
  organization described by that subsection must comply with the
  marketing guidelines established by the commission under Section
  533.008.
         (c)  Nothing in this section prohibits:
               (1)  a provider participating in the Medicaid or child
  health plan program from:
                     (A)  engaging in a marketing activity, including
  any dissemination of material or other attempt to communicate, that
  is intended to influence the choice of provider by a Medicaid client
  or a parent whose child is enrolled in the Medicaid or child health
  plan program, if the marketing activity:
                           (i)  is conducted at a community-sponsored
  educational event, health fair, outreach activity, or other similar
  community or nonprofit event in which the provider participates and
  does not involve unsolicited personal contact or promotion of the
  provider's practice; or
                           (ii)  involves only the general
  dissemination of information, including by television, radio,
  newspaper, or billboard advertisement, and does not involve
  unsolicited personal contact;
                     (B)  as permitted under the provider's contract,
  engaging in the dissemination of material or another attempt to
  communicate with a Medicaid client or a parent whose child is
  enrolled in the Medicaid or child health plan program, including
  communication in person or by direct mail or telephone, for the
  purpose of:
                           (i)  providing an appointment reminder;
                           (ii)  distributing promotional health
  materials;
                           (iii)  providing information about the types
  of services offered by the provider; or
                           (iv)  coordinating patient care; or
                     (C)  engaging in a marketing activity that has
  been submitted for review and obtained a notice of prior
  authorization from the commission under Subsection (d); or
               (2)  a provider participating in the Medicaid STAR +
  PLUS program from, as permitted under the provider's contract,
  engaging in a marketing activity, including any dissemination of
  material or other attempt to communicate, that is intended to
  educate a Medicaid client about available long-term care services
  and supports.
         (d)  The commission shall establish a process by which
  providers may submit proposed marketing activities for review and
  prior authorization to ensure that providers are in compliance with
  the requirements of this section and, if applicable, Section
  533.008, or to determine whether the providers are exempt from a
  requirement of this section and, if applicable, Section 533.008.  
  The commission may grant or deny a provider's request for
  authorization to engage in a proposed marketing activity.
         (e)  The executive commissioner shall adopt rules as
  necessary to implement this section, including rules relating to
  provider marketing activities that are exempt from the requirements
  of this section and, if applicable, Section 533.008.
         SECTION 3.  Section 531.02414, Government Code, is amended
  by amending Subsection (d) and adding Subsections (g) and (h) to
  read as follows:
         (d)  Subject to Section 533.00257, the [The] commission may
  contract with a public transportation provider, as defined by
  Section 461.002, Transportation Code, a private transportation
  provider, or a regional transportation broker for the provision of
  public transportation services, as defined by Section 461.002,
  Transportation Code, under the medical transportation program.
         (g)  The commission shall enter into a memorandum of
  understanding with the Texas Department of Motor Vehicles and the
  Department of Public Safety for purposes of obtaining the motor
  vehicle registration and driver's license information of a provider
  of medical transportation services, including a regional
  contracted broker and a subcontractor of the broker, to confirm
  that the provider complies with applicable requirements adopted
  under Subsection (e).
         (h)  The commission shall establish a process by which
  providers of medical transportation services, including providers
  under a managed transportation delivery model, that contract with
  the commission may request and obtain the information described
  under Subsection (g) for purposes of ensuring that subcontractors
  providing medical transportation services meet applicable
  requirements adopted under Subsection (e).
         SECTION 4.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.076 to read as follows:
         Sec. 531.076.  REVIEW OF PRIOR AUTHORIZATION AND UTILIZATION
  REVIEW PROCESSES.  (a)  The commission shall periodically review in
  accordance with an established schedule the prior authorization and
  utilization review processes within the Medicaid fee-for-service
  delivery model to determine if those processes need modification to
  reduce authorizations of unnecessary services and inappropriate
  use of services.  The commission shall also monitor the processes
  described in this subsection for anomalies and, on identification
  of an anomaly in a process, shall review the process for
  modification earlier than scheduled.
         (b)  The commission shall monitor Medicaid managed care
  organizations to ensure that the organizations are using prior
  authorization and utilization review processes to reduce
  authorizations of unnecessary services and inappropriate use of
  services.
         SECTION 5.  Section 531.102, Government Code, is amended by
  amending Subsection (a) and adding Subsection (l) to read as
  follows:
         (a)  The [commission, through the] commission's office of
  inspector general[,] is responsible for the prevention, detection,
  audit, inspection, review, and investigation of fraud, waste, and
  abuse in the provision and delivery of all health and human services
  in the state, including services through any state-administered
  health or human services program that is wholly or partly federally
  funded, and the enforcement of state law relating to the provision
  of those services.  The commission may obtain any information or
  technology necessary to enable the office to meet its
  responsibilities under this subchapter or other law.
         (l)  Nothing in this section limits the authority of any
  other state agency or governmental entity.
         SECTION 6.  Subchapter C, Chapter 531, Government Code, is
  amended by adding Section 531.1022 to read as follows:
         Sec. 531.1022.  PEACE OFFICERS. (a)  The commission's
  office of inspector general shall employ and commission not more
  than five peace officers at any given time for the purpose of
  assisting the office in carrying out the duties of the office
  relating to the investigation of fraud, waste, and abuse in the
  Medicaid program.
         (b)  Peace officers employed under this section are
  administratively attached to the Department of Public Safety.  The
  commission shall provide administrative support to the department
  necessary to support the assignment of peace officers employed
  under this section.
         (c)  A peace officer employed and commissioned by the office
  under this section is a peace officer for purposes of Article 2.12,
  Code of Criminal Procedure.
         (d)  A peace officer employed and commissioned under this
  section shall obtain prior approval from the office of attorney
  general before carrying out any duties requiring peace officer
  status.
         SECTION 7.  (a)  Subchapter A, Chapter 533, Government Code,
  is amended by adding Section 533.00257 to read as follows:
         Sec. 533.00257.  DELIVERY OF MEDICAL TRANSPORTATION PROGRAM
  SERVICES. (a)  In this section:
               (1)  "Managed transportation organization" means:
                     (A)  a rural or urban transit district created
  under Chapter 458, Transportation Code;
                     (B)  a public transportation provider defined by
  Section 461.002, Transportation Code;
                     (C)  a regional contracted broker defined by
  Section 531.02414;
                     (D)  a local private transportation provider
  approved by the commission to provide Medicaid nonemergency medical
  transportation services; or
                     (E)  any other entity the commission determines
  meets the requirements of this section.
               (2)  "Medical transportation program" has the meaning
  assigned by Section 531.02414.
               (3)  "Transportation service area provider" means a
  for-profit or nonprofit entity or political subdivision of this
  state that provides demand response, curb-to-curb, nonemergency
  transportation under the medical transportation program.
         (b)  Subject to Subsection (i), the commission shall provide
  medical transportation program services on a regional basis through
  a managed transportation delivery model using managed
  transportation organizations and providers, as appropriate, that:
               (1)  operate under a capitated rate system;
               (2)  assume financial responsibility under a full-risk
  model;
               (3)  operate a call center;
               (4)  use fixed routes when available and appropriate;
  and
               (5)  agree to provide data to the commission if the
  commission determines that the data is required to receive federal
  matching funds.
         (c)  The commission shall procure managed transportation
  organizations under the medical transportation program through a
  competitive bidding process for each managed transportation region
  as determined by the commission.
         (d)  A managed transportation organization that participates
  in the medical transportation program must attempt to contract with
  medical transportation providers that:
               (1)  are considered significant traditional providers,
  as defined by rule by the executive commissioner;
               (2)  meet the minimum quality and efficiency measures
  required under Subsection (g) and other requirements that may be
  imposed by the managed transportation organization; and
               (3)  agree to accept the prevailing contract rate of
  the managed transportation organization.
         (e)  To the extent allowed under federal law, a managed
  transportation organization may own, operate, and maintain a fleet
  of vehicles or contract with an entity that owns, operates, and
  maintains a fleet of vehicles.  The commission shall seek
  appropriate federal waivers or other authorizations to implement
  this subsection as necessary.
         (f)  The commission shall consider the ownership, operation,
  and maintenance of a fleet of vehicles by a managed transportation
  organization to be a related-party transaction for purposes of
  applying experience rebates, administrative costs, and other
  administrative controls determined by the commission.
         (g)  The commission shall require that managed
  transportation organizations and providers participating in the
  medical transportation program meet minimum quality and efficiency
  measures as determined by the commission.
         (h)  The commission may contract with transportation service
  area providers providing services under the medical transportation
  program on September 1, 2013, in not more than three contiguous
  rural or small urban transit districts located within a managed
  transportation region to execute appropriate interlocal agreements
  to consolidate and coordinate medical transportation program
  service delivery activities within the area served by the providers
  for the evaluation of:
               (1)  cost-savings measures;
               (2)  efficiencies;
               (3)  best practices; and
               (4)  available matching funds.
         (i)  The commission may delay providing medical
  transportation program services through a managed transportation
  delivery model in areas of this state in which the commission on
  September 1, 2013, is operating a full-risk transportation broker
  model.
         (j)  Notwithstanding Subsection (i), the commission may not
  delay providing medical transportation program services through a
  managed transportation delivery model in:
               (1)  a county with a population of 750,000 or more:
                     (A)  in which all or part of a municipality with a
  population of one million or more is located; and
                     (B)  that is located adjacent to a county with a
  population of two million or more; or
               (2)  a county with a population of at least 55,000 but
  not more than 65,000 that is located adjacent to a county with a
  population of at least 500,000 but not more than 1.5 million.
         (k)  Subsection (h) and this subsection expire August 31,
  2015.
         (b)  The Health and Human Services Commission shall begin
  providing medical transportation program services through the
  delivery model required by Section 533.00257, Government Code, as
  added by this section, not later than September 1, 2014, subject to
  Subsection (i), Section 533.00257, Government Code, as added by
  this section.
         SECTION 8.  Subsection (a-1), Section 533.005, Government
  Code, is amended to read as follows:
         (a-1)  The requirements imposed by Subsections (a)(23)(A),
  (B), and (C) do not apply, and may not be enforced, on and after
  August 31, 2018 [2013].
         SECTION 9.  (a)  Section 773.0571, Health and Safety Code, is
  amended to read as follows:
         Sec. 773.0571.  REQUIREMENTS FOR PROVIDER LICENSE. The
  department shall issue to an emergency medical services provider
  applicant a license that is valid for two years if the department is
  satisfied that:
               (1)  the applicant [emergency medical services
  provider] has adequate staff to meet the staffing standards
  prescribed by this chapter and the rules adopted under this
  chapter;
               (2)  each emergency medical services vehicle is
  adequately constructed, equipped, maintained, and operated to
  render basic or advanced life support services safely and
  efficiently;
               (3)  the applicant [emergency medical services
  provider] offers safe and efficient services for emergency
  prehospital care and transportation of patients; [and]
               (4)  the applicant:
                     (A)  possesses sufficient professional experience
  and qualifications to provide emergency medical services; and
                     (B)  has not been excluded from participation in
  the state Medicaid program;
               (5)  the applicant holds a letter of approval issued
  under Section 773.0573 by the governing body of the municipality or
  the commissioners court of the county in which the applicant is
  located and is applying to provide emergency medical services, as
  applicable;
               (6)  the applicant employs a medical director; and
               (7)  the applicant [emergency medical services
  provider] complies with the rules adopted [by the board] under this
  chapter.
         (b)  Subchapter C, Chapter 773, Health and Safety Code, is
  amended by adding Sections 773.05711, 773.05712, and 773.05713 to
  read as follows:
         Sec. 773.05711.  ADDITIONAL EMERGENCY MEDICAL SERVICES
  PROVIDER LICENSE REQUIREMENTS.  (a)  In addition to the
  requirements for obtaining or renewing an emergency medical
  services provider license under this subchapter, a person who
  applies for a license or for a renewal of a license must:
               (1)  provide the department with a letter of credit
  issued by a federally insured bank or savings institution in the
  amount of:
                     (A)  $100,000 for the initial license and for
  renewal of the license on the second anniversary of the date the
  initial license is issued;
                     (B)  $75,000 for renewal of the license on the
  fourth anniversary of the date the initial license is issued;
                     (C)  $50,000 for renewal of the license on the
  sixth anniversary of the date the initial license is issued; and
                     (D)  $25,000 for renewal of the license on the
  eighth anniversary of the date the initial license is issued;
               (2)  if the applicant participates in the medical
  assistance program operated under Chapter 32, Human Resources Code,
  the Medicaid managed care program operated under Chapter 533,
  Government Code, or the child health plan program operated under
  Chapter 62 of this code, provide the Health and Human Services
  Commission with a surety bond in the amount of $50,000; and
               (3)  submit for approval by the department the name and
  contact information of the provider's administrator of record who
  satisfies the requirements under Section 773.05712.
         (b)  An emergency medical services provider that is directly
  operated by a governmental entity is exempt from this section.
         Sec. 773.05712.  ADMINISTRATOR OF RECORD.  (a)  The
  administrator of record for an emergency medical services provider
  licensed under this subchapter:
               (1)  may not be employed or otherwise compensated by
  another private for-profit emergency medical services provider;
               (2)  must meet the qualifications required for an
  emergency medical technician or other health care professional
  license or certification issued by this state; and
               (3)  must submit to a criminal history record check at
  the applicant's expense.
         (b)  Section 773.0415 does not apply to information an
  administrator of record is required to provide under this section.
         (c)  An administrator of record initially approved by the
  department may be required to complete an education course for new
  administrators of record.  The executive commissioner shall
  recognize, prepare, or administer the education course for new
  administrators of record, which must include information about the
  laws and department rules that affect emergency medical services
  providers.
         (d)  An administrator of record approved by the department
  under Section 773.05711(a) annually must complete at least eight
  hours of continuing education following initial approval.  The
  executive commissioner shall recognize, prepare, or administer
  continuing education programs for administrators of record, which
  must include information about changes in law and department rules
  that affect emergency medical services providers.
         (e)  Subsection (a)(2) does not apply to an emergency medical
  services provider that held a license on September 1, 2013, and has
  an administrator of record who has at least eight years of
  experience providing emergency medical services.
         (f)  An emergency medical services provider that is directly
  operated by a governmental entity is exempt from this section.
         Sec. 773.05713.  REPORT TO LEGISLATURE.  Not later than
  December 1 of each even-numbered year, the department shall
  electronically submit a report to the lieutenant governor, the
  speaker of the house of representatives, and the standing
  committees of the house and senate with jurisdiction over the
  department on the effect of Sections 773.05711 and 773.05712 that
  includes:
               (1)  the total number of applications for emergency
  medical services provider licenses submitted to the department and
  the number of applications for which licenses were issued or
  licenses were denied by the department;
               (2)  the number of emergency medical services provider
  licenses that were suspended or revoked by the department for
  violations of those sections and a description of the types of
  violations that led to the license suspension or revocation;
               (3)  the number of occurrences and types of fraud
  committed by licensed emergency medical services providers related
  to those sections;
               (4)  the number of complaints made against licensed
  emergency medical services providers for violations of those
  sections and a description of the types of complaints; and
               (5)  the status of any coordination efforts of the
  department and the Texas Medical Board related to those sections.
         (c)  Subchapter C, Chapter 773, Health and Safety Code, is
  amended by adding Section 773.0573 to read as follows:
         Sec. 773.0573.  LETTER OF APPROVAL FROM LOCAL GOVERNMENTAL
  ENTITY. (a)  An emergency medical services provider applicant must
  obtain a letter of approval from:
               (1)  the governing body of the municipality in which
  the applicant is located and is applying to provide emergency
  medical services; or
               (2)  if the applicant is not located in a municipality,
  the commissioners court of the county in which the applicant is
  located and is applying to provide emergency medical services.
         (b)  A governing body of a municipality or a commissioners
  court of a county may issue a letter of approval to an emergency
  medical services provider applicant who is applying to provide
  emergency medical services in the municipality or county only if
  the governing body or commissioners court determines that:
               (1)  the addition of another licensed emergency medical
  services provider will not interfere with or adversely affect the
  provision of emergency medical services by the licensed emergency
  medical services providers operating in the municipality or county;
               (2)  the addition of another licensed emergency medical
  services provider will remedy an existing provider shortage that
  cannot be resolved through the use of the licensed emergency
  medical services providers operating in the municipality or county;
  and
               (3)  the addition of another licensed emergency medical
  services provider will not cause an oversupply of licensed
  emergency medical services providers in the municipality or county.
         (c)  An emergency medical services provider is prohibited
  from expanding operations to or stationing any emergency medical
  services vehicles in a municipality or county other than the
  municipality or county from which the provider obtained the letter
  of approval under this section until after the second anniversary
  of the date the provider's initial license was issued, unless the
  expansion or stationing occurs in connection with:
               (1)  a contract awarded by another municipality or
  county for the provision of emergency medical services;
               (2)  an emergency response made in connection with an
  existing mutual aid agreement; or
               (3)  an activation of a statewide emergency or disaster
  response by the department.
         (d)  This section does not apply to:
               (1)  renewal of an emergency medical services provider
  license; or
               (2)  a municipality, county, emergency services
  district, hospital, or emergency medical services volunteer
  provider organization in this state that applies for an emergency
  medical services provider license.
         (d)  Subchapter C, Chapter 773, Health and Safety Code, is
  amended by adding Section 773.06141 to read as follows:
         Sec. 773.06141.  SUSPENSION, REVOCATION, OR DENIAL OF
  EMERGENCY MEDICAL SERVICES PROVIDER LICENSE.  (a)  The
  commissioner may suspend, revoke, or deny an emergency medical
  services provider license on the grounds that the provider's
  administrator of record, employee, or other representative:
               (1)  has been convicted of, or placed on deferred
  adjudication community supervision or deferred disposition for, an
  offense that directly relates to the duties and responsibilities of
  the administrator, employee, or representative, other than an
  offense for which points are assigned under Section 708.052,
  Transportation Code;
               (2)  has been convicted of or placed on deferred
  adjudication community supervision or deferred disposition for an
  offense, including:
                     (A)  an offense listed in Sections 3g(a)(1)(A)
  through (H), Article 42.12, Code of Criminal Procedure; or
                     (B)  an offense, other than an offense described
  by Subdivision (1), for which the person is subject to registration
  under Chapter 62, Code of Criminal Procedure; or
               (3)  has been convicted of Medicare or Medicaid fraud,
  has been excluded from participation in the state Medicaid program,
  or has a hold on payment for reimbursement under the state Medicaid
  program under Subchapter C, Chapter 531, Government Code.
         (b)  An emergency medical services provider that is directly
  operated by a governmental entity is exempt from this section.
         (e)  Notwithstanding Chapter 773, Health and Safety Code, as
  amended by this section, the Department of State Health Services
  may not issue any new emergency medical services provider licenses
  for the period beginning on September 1, 2013, and ending on August
  31, 2014. The moratorium does not apply to the issuance of an
  emergency medical services provider license to a municipality,
  county, emergency services district, hospital, or emergency
  medical services volunteer provider organization in this state, or
  to an emergency medical services provider applicant who is applying
  to provide services in response to 9-1-1 calls and is located in a
  rural area, as that term is defined in Section 773.0045, Health and
  Safety Code.
         (f)  Section 773.0571, Health and Safety Code, as amended by
  this section, and Section 773.0573, Health and Safety Code, as
  added by this section, apply only to an application for approval of
  an emergency medical services provider license submitted to the
  Department of State Health Services on or after the effective date
  of this Act.  An application submitted before the effective date of
  this Act is governed by the law in effect immediately before the
  effective date of this Act, and that law is continued in effect for
  that purpose.
         (g)  The changes in law made by this section apply only to an
  application for approval or renewal of an emergency medical
  services provider license submitted to the Department of State
  Health Services on or after the effective date of this Act.  An
  application submitted before the effective date of this Act is
  governed by the law in effect immediately before the effective date
  of this Act, and that law is continued in effect for that purpose.
         SECTION 10.  Section 32.0322, Human Resources Code, is
  amended by amending Subsection (b) and adding Subsections (b-1),
  (e), and (f) to read as follows:
         (b)  Subject to Subsections (b-1) and (e), the [The]
  executive commissioner of the Health and Human Services Commission
  by rule shall establish criteria for the department or the
  commission's office of inspector general to suspend a provider's
  billing privileges under the medical assistance program, revoke a
  provider's enrollment under the program, or deny a person's
  application to enroll as a provider under the program based on:
               (1)  the results of a criminal history check;
               (2)  any exclusion or debarment of the provider from
  participation in a state or federally funded health care program;
               (3)  the provider's failure to bill for medical
  assistance or refer clients for medical assistance within a
  12-month period; or
               (4)  any of the provider screening or enrollment
  provisions contained in 42 C.F.R. Part 455, Subpart E.
         (b-1)  In adopting rules under this section, the executive
  commissioner of the Health and Human Services Commission shall
  require revocation of a provider's enrollment or denial of a
  person's application for enrollment as a provider under the medical
  assistance program if the person has been excluded or debarred from
  participation in a state or federally funded health care program as
  a result of:
               (1)  a criminal conviction or finding of civil or
  administrative liability for committing a fraudulent act, theft,
  embezzlement, or other financial misconduct under a state or
  federally funded health care program; or
               (2)  a criminal conviction for committing an act under
  a state or federally funded health care program that caused bodily
  injury to:
                     (A)  a person who is 65 years of age or older;
                     (B)  a person with a disability; or
                     (C)  a person under 18 years of age.
         (e)  The department may reinstate a provider's enrollment
  under the medical assistance program or grant a person's previously
  denied application to enroll as a provider, including a person
  described by Subsection (b-1), if the department finds:
               (1)  good cause to determine that it is in the best
  interest of the medical assistance program; and
               (2)  the person has not committed an act that would
  require revocation of a provider's enrollment or denial of a
  person's application to enroll since the person's enrollment was
  revoked or application was denied, as appropriate.
         (f)  The department must support a determination made under
  Subsection (e) with written findings of good cause for the
  determination.
         SECTION 11.  Section 32.073, Human Resources Code, is
  amended by adding Subsection (c) to read as follows:
         (c)  Not later than the second anniversary of the date
  national standards for electronic prior authorization of benefits
  are adopted, the Health and Human Services Commission shall require
  a health benefit plan issuer participating in the medical
  assistance program or the agent of the health benefit plan issuer
  that manages or administers prescription drug benefits to exchange
  prior authorization requests electronically with a prescribing
  provider participating in the medical assistance program who has
  electronic prescribing capability and who initiates a request
  electronically.
         SECTION 12.  Section 36.005, Human Resources Code, is
  amended by amending Subsection (b-1) and adding Subsections (e),
  (f), and (g) to read as follows:
         (b-1)  The period of ineligibility begins on the date on
  which the judgment finding the provider liable under Section 36.052
  is entered by the trial court [determination that the provider is
  liable becomes final].
         (e)  Notwithstanding Subsection (b-1), the period of
  ineligibility for an individual licensed by a health care
  regulatory agency or a physician begins on the date on which the
  determination that the individual or physician is liable becomes
  final.
         (f)  For purposes of Subsection (e), a "physician" includes a
  physician, a professional association composed solely of
  physicians, a single legal entity authorized to practice medicine
  owned by two or more physicians, a nonprofit health corporation
  certified by the Texas Medical Board under Chapter 162, Occupations
  Code, or a partnership composed solely of physicians.
         (g)  For purposes of Subsection (e), "health care regulatory
  agency" has the meaning assigned by Section 774.001, Government
  Code.
         SECTION 13.  (a)  The Health and Human Services Commission,
  in cooperation with the Department of State Health Services and the
  Texas Medical Board, shall:
               (1)  as soon as practicable after the effective date of
  this Act, conduct a thorough review of and solicit stakeholder
  input regarding the laws and policies related to the use of
  non-emergent services provided by ambulance providers under the
  medical assistance program established under Chapter 32, Human
  Resources Code;
               (2)  not later than January 1, 2014, make
  recommendations to the legislature regarding suggested changes to
  the law that would reduce the incidence of and opportunities for
  fraud, waste, and abuse with respect to the activities described by
  Subdivision (1) of this subsection; and
               (3)  amend the policies described by Subdivision (1) of
  this subsection as necessary to assist in accomplishing the goals
  described by Subdivision (2) of this subsection.
         (b)  This section expires September 1, 2015.
         SECTION 14.  (a)  The Department of State Health Services,
  in cooperation with the Health and Human Services Commission and
  the Texas Medical Board, shall:
               (1)  as soon as practicable after the effective date of
  this Act, conduct a thorough review of and solicit stakeholder
  input regarding the laws and policies related to the licensure of
  nonemergency transportation providers;
               (2)  not later than January 1, 2014, make
  recommendations to the legislature regarding suggested changes to
  the law that would reduce the incidence of and opportunities for
  fraud, waste, and abuse with respect to the activities described by
  Subdivision (1) of this subsection; and
               (3)  amend the policies described by Subdivision (1) of
  this subsection as necessary to assist in accomplishing the goals
  described by Subdivision (2) of this subsection.
         (b)  This section expires September 1, 2015.
         SECTION 15.  (a)  The Texas Medical Board, in cooperation
  with the Department of State Health Services and the Health and
  Human Services Commission, shall:
               (1)  as soon as practicable after the effective date of
  this Act, conduct a thorough review of and solicit stakeholder
  input regarding the laws and policies related to:
                     (A)  the delegation of health care services by
  physicians or medical directors to qualified emergency medical
  services personnel; and
                     (B)  physicians' assessment of patients' needs for
  purposes of ambulatory transfer or transport or other purposes;
               (2)  not later than January 1, 2014, make
  recommendations to the legislature regarding suggested changes to
  the law that would reduce the incidence of and opportunities for
  fraud, waste, and abuse with respect to the activities described by
  Subdivision (1) of this subsection; and
               (3)  amend the policies described by Subdivision (1) of
  this subsection as necessary to assist in accomplishing the goals
  described by Subdivision (2) of this subsection.
         (b)  This section expires September 1, 2015.
         SECTION 16.  (a)  The Health and Human Services Commission
  shall study the feasibility of developing and implementing a single
  standard prior authorization form to be used for requesting prior
  authorization for prescription drugs in the medical assistance
  program by participating prescribers who do not have electronic
  prescribing capability and are not able to initiate electronic
  prior authorization requests. The commission shall complete the
  study not later than December 31, 2014.
         (b)  If the Health and Human Services Commission determines
  that developing and implementing the form described in Subsection
  (a) of this section is feasible, will reduce administrative
  burdens, and is cost-effective, the commission shall adjust
  contracts with participating health benefit plan issuers and
  participating health benefit plan administrators to require
  acceptance of the form.
         SECTION 17.  (a) The office of inspector general of the
  Health and Human Services Commission shall review the manner in
  which:
               (1)  the office investigates fraud, waste, and abuse in
  the supplemental nutrition assistance program under Chapter 33,
  Human Resources Code, including in the provision of benefits under
  that program; and
               (2)  the office coordinates with other state and
  federal agencies in conducting those investigations.
         (b)  Not later than September 1, 2014, and based on the
  review required by Subsection (a) of this section, the office of
  inspector general of the Health and Human Services Commission shall
  submit to the legislature a written report containing strategies
  for addressing fraud, waste, and abuse in the supplemental
  nutrition assistance program under Chapter 33, Human Resources
  Code, including in the provision of benefits under that program.
         (c)  This section expires January 1, 2015.
         SECTION 18.  (a)  This section is a clarification of
  legislative intent regarding Subsection (s), Section 32.024, Human
  Resources Code, and a validation of certain Health and Human
  Services Commission acts and decisions.
         (b)  In 1999, the legislature became aware that certain
  children enrolled in the Medicaid program were receiving treatment
  under the program outside the presence of a parent or another
  responsible adult.  The treatment of unaccompanied children under
  the Medicaid program resulted in the provision of unnecessary
  services to those children, the exposure of those children to
  unnecessary health and safety risks, and the submission of
  fraudulent claims by Medicaid providers.
         (c)  In addition, in 1999, the legislature became aware of
  allegations that certain Medicaid providers were offering money and
  other gifts in exchange for a parent's or child's consent to receive
  unnecessary services under the Medicaid program.  In some cases, a
  child was offered money or gifts in exchange for the parent's or
  child's consent to have the child transported to a different
  location to receive unnecessary services.  In some of those cases,
  once transported, the child received no treatment and was left
  unsupervised for hours before being transported home.  The
  provision of money and other gifts by Medicaid providers in
  exchange for parents' or children's consent to services deprived
  those parents and children of the right to choose a Medicaid
  provider without improper inducement.
         (d)  In response, in 1999, the legislature enacted Chapter
  766 (H.B. 1285), Acts of the 76th Legislature, Regular Session,
  1999, which amended Section 32.024, Human Resources Code, by
  amending Subsection (s) and adding Subsection (s-1).  As amended,
  Subsection (s), Section 32.024, Human Resources Code, requires that
  a child's parent or guardian or another adult authorized by the
  child's parent or guardian accompany the child at a visit or
  screening under the early and periodic screening, diagnosis, and
  treatment program in order for a Medicaid provider to be reimbursed
  for services provided at the visit or screening.  As filed, the bill
  required a child's parent or guardian to accompany the child.  The
  house committee report added the language allowing an adult
  authorized by the child's parent or guardian to accompany the child
  in order to accommodate a parent or guardian for whom accompanying
  the parent's or guardian's child to each visit or screening would be
  a hardship.
         (e)  The legislature finds that:
               (1)  in amending Subsection (s), Section 32.024, Human
  Resources Code, in 1999, the legislature did not intend to:
                     (A)  create a hardship for families whose
  circumstances prevent a parent or guardian from accompanying the
  parent's or guardian's child to each visit or screening under the
  early and periodic screening, diagnosis, and treatment program; and
                     (B)  compromise a child's access to medically
  necessary services or to require a parent or guardian to jeopardize
  his or her employment or the health and safety of other children in
  the household;
               (2)  in enacting and enforcing administrative rules and
  policies to implement the parental accompaniment requirement of
  Subsection (s), Section 32.024, Human Resources Code, the Health
  and Human Services Commission should give special consideration and
  should reasonably accommodate the circumstances of a child who
  lives in a single parent or guardian family and whose parent or
  guardian:
                     (A)  has a full-time job that does not allow the
  parent or guardian to take time off during a provider's regular
  business hours;
                     (B)  attends school or participates in a job
  training program that requires the parent's or guardian's full-time
  attendance and does not allow absences for medical or personal
  needs;
                     (C)  is the caretaker of two or more children and
  does not have access to child care;
                     (D)  has a disability or illness that prevents the
  parent or guardian from safely accompanying the child to a visit or
  screening; or
                     (E)  is the primary caregiver of a person who has a
  disability or illness and for whom no alternate caregiver is
  available; and
               (3)  in developing reasonable accommodations described
  by this subsection, the Health and Human Services Commission should
  not allow the provider of a service or an affiliate of the provider
  to accompany the child as an authorized adult for purposes of
  Paragraph (B), Subdivision (2), Subsection (s), Section 32.024,
  Human Resources Code.
         (f)  The principal purposes of Chapter 766 (H.B. 1285), Acts
  of the 76th Legislature, Regular Session, 1999, were to prevent
  Medicaid providers from committing fraud, encourage parental
  involvement in and management of health care of children enrolled
  in the early and periodic screening, diagnosis, and treatment
  program, and ensure the safety of children receiving services under
  the Medicaid program.  The addition of the language allowing an
  adult authorized by a child's parent or guardian to accompany the
  child furthered each of those purposes.
         (g)  The legislature, in amending Subsection (s), Section
  32.024, Human Resources Code, understood that:
               (1)  the effectiveness of medical, dental, and therapy
  services provided to a child improves when the child's parent or
  guardian actively participates in the delivery of those services;
               (2)  a parent is responsible for the safety and
  well-being of the parent's child, and that a parent cannot casually
  delegate this responsibility to a stranger;
               (3)  a parent may not always be available to accompany
  the parent's child at a visit to the child's doctor, dentist, or
  therapist; and
               (4)  Medicaid providers and their employees and
  associates have a financial interest in the delivery of services
  under the Medicaid program and, accordingly, cannot fulfill the
  responsibilities of a parent or guardian when providing services to
  a child.
         (h)(1)  On March 15, 2012, the Health and Human Services
  Commission notified certain Medicaid providers that state law and
  commission policy require a child's parent or guardian or another
  properly authorized adult to accompany a child receiving services
  under the Medicaid program.  This notice followed the commission's
  discovery that some providers were transporting children from
  schools to therapy clinics and other locations to receive therapy
  services.  Although the children were not accompanied by a parent or
  guardian during these trips, the providers were obtaining
  reimbursement for the trips under the Medicaid medical
  transportation program.  The commission clarified in the notice
  that, in order for a provider to be reimbursed for transportation
  services provided to a child under the Medicaid medical
  transportation program, the child must be accompanied by the
  child's parent or guardian or another adult who is not the provider
  and whom the child's parent or guardian has authorized to accompany
  the child by submitting signed, written consent to the provider.
               (2)  In May 2012, a lawsuit was filed to enjoin the
  Health and Human Services Commission from enforcing Subsection (s),
  Section 32.024, Human Resources Code, and 1 T.A.C. Section 380.207,
  as interpreted in certain notices issued by the commission.  A state
  district court enjoined the commission from denying eligibility to
  a child for transportation services under the Medicaid medical
  transportation program if the child's parent or guardian does not
  accompany the child, provided that the child's parent or guardian
  authorizes any other adult to accompany the child.  The court also
  enjoined the commission from requiring as a condition for a
  provider to be reimbursed for services provided to a child during a
  visit or screening under the early and periodic screening,
  diagnosis, and treatment program that the child be accompanied by
  the child's parent or guardian, provided that the child's parent or
  guardian authorizes another adult to accompany the child.  The
  state has filed a notice of appeal of the court's order.
               (3)  The legislature declares that a rule or policy
  adopted by the Health and Human Services Commission before the
  effective date of this Act to require that, in order for a Medicaid
  provider to be reimbursed for services provided to a child under the
  early and periodic screening, diagnosis, and treatment program or
  the medical transportation program, the child must be accompanied
  by the child's parent or guardian or another adult whom the child's
  parent or guardian has authorized to accompany the child is
  conclusively presumed, as of the date the rule or policy was
  adopted, to be a valid exercise of the commission's authority and
  consistent with the intent of the legislature, provided that the
  rule or policy:
                     (A)  was adopted pursuant to Subsection (s),
  Section 32.024, Human Resources Code; and
                     (B)  prohibits the child's parent or guardian from
  authorizing the provider or the provider's employee or associate as
  an adult who may accompany the child.
               (4)  Subdivision (3) of this subsection does not apply to:
                     (A)  an action or decision that was void at the
  time the action was taken or the decision was made;
                     (B)  an action or decision that violates federal
  law or the terms of a federal waiver; or
                     (C)  an action or decision that, under a statute
  of this state or the United States, was a misdemeanor or felony at
  the time the action was taken or the decision was made.
               (5)  This section does not apply to:
                     (A)  an action or decision that was void at the
  time the action was taken or the decision was made;
                     (B)  an action or decision that violates federal
  law or the terms of a federal waiver; or
                     (C)  an action or decision that, under a statute
  of this state or the United States, was a misdemeanor or felony at
  the time the action was taken or the decision was made.
         SECTION 19.  As soon as practicable after the effective date of
  this Act, the executive commissioner of the Health and Human Services
  Commission shall establish the data analysis unit required under Section
  531.0082, Government Code, as added by this Act.  The data analysis unit
  shall provide the initial update required under Subsection (d), Section
  531.0082, Government Code, as added by this Act, not later than the 30th
  day after the last day of the first complete calendar quarter occurring
  after the date the unit is established.
         SECTION 20.  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 21.  This Act takes effect September 1, 2013.
 
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 8 passed the Senate on
  April 15, 2013, by the following vote:  Yeas 30, Nays 0, one
  present not voting; May 22, 2013, Senate refused to concur in House
  amendments and requested appointment of Conference Committee;
  May 23, 2013, House granted request of the Senate; May 24, 2013,
  Senate adopted Conference Committee Report by the following
  vote:  Yeas 27, Nays 4.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 8 passed the House, with
  amendments, on May 20, 2013, by the following vote:  Yeas 144,
  Nays 0, two present not voting; May 23, 2013, House granted request
  of the Senate for appointment of Conference Committee;
  May 26, 2013, House adopted Conference Committee Report by the
  following vote:  Yeas 105, Nays 38, one present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
             Date
 
 
  ______________________________ 
            Governor