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