80(R) SB 10 - Enrolled version

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	S.B. No. 10




	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; providing penalties.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1. Subchapter B, Chapter 531, Government Code, is
	amended by adding Section 531.02192 to read as follows:
	Sec. 531.02192. FEDERALLY QUALIFIED HEALTH CENTER AND RURAL
	HEALTH CLINIC SERVICES. (a) In this section:
	(1) "Federally qualified health center" has the
	meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
	(2) "Federally qualified health center services" has
	the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
	(3) "Rural health clinic" and "rural health clinic
	services" have the meanings assigned by 42 U.S.C. Section
	1396d(l)(1).
	(b) Notwithstanding any provision of this chapter, Chapter
	32, Human Resources Code, or any other law, the commission shall:
	(1) promote Medicaid recipient access to federally
	qualified health center services or rural health clinic services;
	and
	(2) ensure that payment for federally qualified health
	center services or rural health clinic services is in accordance
	with 42 U.S.C. Section 1396a(bb).
	SECTION 2. Subchapter B, Chapter 531, Government Code, is
	amended by adding Section 531.02413 to read as follows:
	Sec. 531.02413. BILLING COORDINATION SYSTEM. (a) If
	cost-effective and feasible, the commission shall, on or before
	March 1, 2008, contract through an existing procurement process for
	the implementation of an acute care Medicaid billing coordination
	system for the fee-for-service and primary care case management
	delivery models that will, upon entry in the claims system,
	identify within 24 hours whether another entity has primary
	responsibility for paying the claim and submit the claim to the
	entity the system determines is the primary payor. The system may
	not increase Medicaid claims payment error rates.
	(b) If cost-effective, the executive commissioner shall
	adopt rules for the purpose of enabling the system to identify an
	entity with primary responsibility for paying a claim and establish
	reporting requirements for any entity that may have a contractual
	responsibility to pay for the types of acute care services provided
	under the Medicaid program.
	(c) An entity that holds a permit, license, or certificate
	of authority issued by a regulatory agency of the state must allow
	the contractor under Subsection (a) access to databases to allow
	the contractor to carry out the purposes of this section, subject to
	the contractor's contract with the commission and rules adopted
	under this section, and is subject to an administrative penalty or
	other sanction as provided by the law applicable to the permit,
	license, or certificate of authority for a violation by the entity
	of a rule adopted under this section.
	(d) After September 1, 2008, no public funds shall be
	expended on entities not in compliance with this section unless a
	memorandum of understanding is entered into between the entity and
	the executive commissioner.
	(e) Information obtained under this section is
	confidential. The contractor may use the information only for the
	purposes authorized under this section. A person commits an
	offense if the person knowingly uses information obtained under
	this section for any purpose not authorized under this section. An
	offense under this subsection is a Class B misdemeanor and all other
	penalties may apply.
	SECTION 3. (a) Subchapter B, Chapter 531, Government Code,
	is amended by adding Section 531.02414 to read as follows:
	Sec. 531.02414. ADMINISTRATION AND OPERATION OF MEDICAL
	TRANSPORTATION PROGRAM. (a) In this section, "medical
	transportation program" means the program that provides
	nonemergency transportation services to and from covered health
	care services, based on medical necessity, to recipients under the
	Medicaid program, the children with special health care needs
	program, and the transportation for indigent cancer patients
	program, who have no other means of transportation.
	(b) Notwithstanding any other law, the commission shall
	directly supervise the administration and operation of the medical
	transportation program.
	(c) Notwithstanding any other law, the commission may not
	delegate the commission's duty to supervise the medical
	transportation program to any other person, including through a
	contract with the Texas Department of Transportation for the
	department to assume any of the commission's responsibilities
	relating to the provision of services through that program.
	(d) 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.
	(b) Subchapter A, Chapter 531, Government Code, is amended
	by adding Section 531.0057 to read as follows:
	Sec. 531.0057. MEDICAL TRANSPORTATION SERVICES. (a) The
	commission shall provide medical transportation services for
	clients of eligible health and human services programs.
	(b) The commission may contract with any public or private
	transportation provider or with any regional transportation broker
	for the provision of public transportation services.
	SECTION 4. (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 AND OTHER PROGRAMS 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 positive 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 credits in the accounts that may be exchanged
	for health-related items specified by the commission that are not
	covered by Medicaid; and
	(3) any other positive 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) In addition to developing and implementing the pilot
	program under this section, the commission may, if feasible and
	cost-effective, develop and implement an additional incentive
	program to encourage Medicaid recipients who are younger than 21
	years of age to make timely health care visits under the early and
	periodic screening, diagnosis, and treatment program. The
	commission shall provide incentives under the program for managed
	care organizations contracting with the commission under Chapter
	533 and Medicaid providers to encourage those organizations and
	providers to support the delivery and documentation of timely and
	complete health care screenings under the early and periodic
	screening, diagnosis, and treatment program.
	(f) This section expires September 1, 2011.
	Sec. 531.0941. MEDICAID HEALTH SAVINGS ACCOUNT PILOT
	PROGRAM. (a) If the commission determines that it is
	cost-effective and 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 by adult recipients; and
	(2) promote appropriate utilization of Medicaid
	services by adult recipients.
	(b) If the commission implements the pilot program, the
	commission may only include adult recipients as participants in the
	program.
	(c) If the commission implements the pilot program, the
	commission shall ensure that:
	(1) participation in the pilot program is voluntary;
	and
	(2) a recipient who participates in the pilot program
	may, at the recipient's option and subject to Subsection (d),
	discontinue participation in the program and resume receiving
	benefits and services under the traditional Medicaid delivery
	model.
	(d) A recipient who chooses to discontinue participation in
	the pilot program and resume receiving benefits and services under
	the traditional Medicaid delivery model before completion of the
	health savings account enrollment period forfeits any funds
	remaining in the recipient's health savings account.
	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,
	subject to Subsection (c), 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) The commission:
	(1) shall develop a tailored benefit package that is
	customized to meet the health care needs of Medicaid recipients who
	are children with special health care needs, subject to approval of
	the waiver described by Subsection (a); and
	(2) may develop tailored benefit packages that are
	customized to meet the health care needs of other categories of
	Medicaid recipients.
	(c) If the commission develops tailored benefit packages
	under Subsection (b)(2), the commission shall submit a report to
	the standing committees of the senate and house of representatives
	having primary jurisdiction over the Medicaid program that
	specifies, in detail, the categories of Medicaid recipients to
	which each of those packages will apply and the services available
	under each package. The commission may not implement a package
	developed under Subsection (b)(2) before September 1, 2009.
	(d) Except as otherwise provided by this section 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.
	(e) 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.
	(f) In addition to the benefits required by Subsection (e),
	a tailored benefit package developed under this section that
	applies to Medicaid recipients who are children must provide at
	least the services required by federal law under the early and
	periodic screening, diagnosis, and treatment program.
	(g) 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.
	(g-1) A tailored benefit package developed under this
	section must increase the state's flexibility with respect to the
	state's use of Medicaid funding and may not reduce the benefits
	available under the Medicaid state plan to any Medicaid recipient
	population.
	(h) In developing the tailored benefit packages, the
	commission shall consider similar benefit packages established in
	other states as a guide.
	(i) 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 categories must include children with
	special health care needs and may include:
	(1) persons with disabilities or special health needs;
	(2) elderly persons;
	(3) children without special health care needs; and
	(4) working-age parents and caretaker relatives.
	(j) This section does not apply to a tailored benefit
	package or similar package of benefits if, before September 1,
	2007:
	(1) a federal waiver was requested to implement the
	package of benefits;
	(2) the package of benefits is being developed, as
	directed by the legislature; or
	(3) the package of benefits has been implemented.
	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 5. Subchapter B, Chapter 531, Government Code, is
	amended by adding Section 531.0972 to read as follows:
	Sec. 531.0972. PILOT PROGRAM TO PREVENT THE SPREAD OF
	CERTAIN INFECTIOUS OR COMMUNICABLE DISEASES. The commission may
	provide guidance to the local health authority of Bexar County in
	establishing a pilot program funded by the county to prevent the
	spread of HIV, hepatitis B, hepatitis C, and other infectious and
	communicable diseases. The program may include a disease control
	program that provides for the anonymous exchange of used hypodermic
	needles and syringes.
	SECTION 6. (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 Subsection (b), Section
	531.1112, Government Code, as added by this section, that the
	commission has implemented or intends to implement.
	SECTION 7. (a) Chapter 531, Government Code, is amended by
	adding Subchapter N to read as follows:
	SUBCHAPTER N. TEXAS HEALTH OPPORTUNITY POOL TRUST FUND
	Sec. 531.501. DEFINITION. In this subchapter, "fund" means
	the Texas health opportunity pool trust fund established under
	Section 531.503.
	Sec. 531.502. DIRECTION TO OBTAIN FEDERAL WAIVER. (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 using that federal money, appropriated
	state money to the extent necessary, and any other money described
	by this section for purposes consistent with this subchapter.
	(b) The executive commissioner may include the following
	federal money in the waiver:
	(1) all 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 authorized to be pooled
	by Subdivisions (1) and (2); and
	(4) any other money available for that purpose,
	including federal money and money identified under Subsection (c).
	(c) The commission shall seek to optimize federal funding
	by:
	(1) identifying health care related state and local
	funds and program expenditures that, before September 1, 2007, are
	not being matched with federal money; and
	(2) exploring the feasibility of:
	(A) certifying or otherwise using those funds and
	expenditures as state expenditures for which this state may receive
	federal matching money; and
	(B) depositing federal matching money received
	as provided by Paragraph (A) with other federal money deposited as
	provided by Section 531.504, or substituting that federal matching
	money for federal money that otherwise would be received under the
	disproportionate share hospitals and upper payment limit
	supplemental payment programs as a match for local funds received
	by this state through intergovernmental transfers.
	(d) The terms of a waiver approved under this section must:
	(1) include safeguards to ensure that the total amount
	of federal money provided under the disproportionate share
	hospitals and upper payment limit supplemental payment programs
	that is deposited as provided by Section 531.504 is, for a
	particular state fiscal year, at least equal to the greater of the
	annualized amount provided to this state under those supplemental
	payment programs during state fiscal year 2007, excluding amounts
	provided during that state fiscal year that are retroactive
	payments, or the state fiscal years during which the waiver is in
	effect; and
	(2) allow for the development by this state of a
	methodology for allocating money in the fund to:
	(A) offset, in part, the uncompensated health
	care costs incurred by hospitals;
	(B) reduce the number of persons in this state
	who do not have health benefits coverage; and
	(C) maintain and enhance the community public
	health infrastructure provided by hospitals.
	(e) In a waiver under this section, the executive
	commissioner shall seek to:
	(1) obtain maximum flexibility with respect to using
	the money in the fund for purposes consistent with this subchapter;
	(2) include an annual adjustment to the aggregate caps
	under the upper payment limit supplemental payment program to
	account for inflation, population growth, and other appropriate
	demographic factors that affect the ability of residents of this
	state to obtain health benefits coverage;
	(3) ensure, for the term of the waiver, that the
	aggregate caps under the upper payment limit supplemental payment
	program for each of the three classes of hospitals are not less than
	the aggregate caps that applied during state fiscal year 2007; and
	(4) to the extent allowed by federal law, including
	federal regulations, and federal waiver authority, preserve the
	federal supplemental payment program payments made to hospitals,
	the state match with respect to which is funded by
	intergovernmental transfers or certified public expenditures that
	are used to optimize Medicaid payments to safety net providers for
	uncompensated care, and preserve allocation methods for those
	payments, unless the need for the payments is revised through
	measures that reduce the Medicaid shortfall or uncompensated care
	costs.
	(f) The executive commissioner shall seek broad-based
	stakeholder input in the development of the waiver under this
	section and shall provide information to stakeholders regarding the
	terms and components of the waiver for which the executive
	commissioner seeks federal approval.
	(g) The executive commissioner shall seek the advice of the
	Legislative Budget Board before finalizing the terms and conditions
	of the negotiated waiver.
	Sec. 531.503. ESTABLISHMENT OF TEXAS HEALTH OPPORTUNITY
	POOL TRUST FUND. Subject to approval of the waiver authorized by
	Section 531.502, the Texas health opportunity pool trust fund is
	created as a trust fund outside the state treasury to be held by the
	comptroller and administered by the commission as trustee on behalf
	of residents of this state who do not have private health benefits
	coverage and health care providers providing uncompensated care to
	those persons. The commission may make expenditures of money in the
	fund only for purposes consistent with this subchapter and the
	terms of the waiver authorized by Section 531.502.
	Sec. 531.504. DEPOSITS TO FUND. (a) The comptroller shall
	deposit in the fund:
	(1) all federal money provided to this state under the
	disproportionate share hospitals supplemental payment program and
	the hospital upper payment limit supplemental payment program,
	other than money provided under those programs to state-owned and
	operated hospitals, and all other non-supplemental payment program
	federal money provided to this state that is included in the waiver
	authorized by Section 531.502; and
	(2) state money appropriated to the fund.
	(b) The commission and comptroller may accept gifts,
	grants, and donations from any source for purposes consistent with
	this subchapter and the terms of the waiver. The comptroller shall
	deposit a gift, grant, or donation made for those purposes in the
	fund.
	Sec. 531.505. USE OF FUND IN GENERAL; RULES FOR ALLOCATION.
	(a) Except as otherwise provided by the terms of a waiver
	authorized by Section 531.502, money in the fund may be used:
	(1) subject to Section 531.506, 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
	shall:
	(1) seek input from a broad base of stakeholder
	representatives on the development of rules with respect to, and
	the administration of, the fund; and
	(2) by rule develop a methodology for allocating money
	in the fund that is consistent with the terms of the waiver.
	Sec. 531.506. REIMBURSEMENTS FOR UNCOMPENSATED HEALTH CARE
	COSTS. (a) Except as otherwise provided by the terms of a waiver
	authorized by Section 531.502 and subject to Subsections (b) and
	(c), money in the fund may be allocated to hospitals in this state
	and political subdivisions of this state to defray the costs of
	providing uncompensated health care in this state.
	(b) To be eligible for money from the fund under this
	section, a hospital or political subdivision 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 hospital or political subdivision, 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) regional or local health care 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 531.505(b) must specify the percentage
	of the money from the fund allocated to a hospital or political
	subdivision that the hospital or political subdivision must use for
	strategies described by Subsection (b).
	Sec. 531.507. INCREASING ACCESS TO HEALTH BENEFITS
	COVERAGE. (a) Except as otherwise provided by the terms of a
	waiver authorized by Section 531.502, money in the fund 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;
	(2) making contributions to health savings accounts
	for those persons; and
	(3) providing other financial assistance to those
	persons through alternate mechanisms established by hospitals in
	this state or political subdivisions of this state that meet
	certain criteria, as specified by the commission.
	(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;
	(3) the process by which that assistance will be paid;
	and
	(4) the mechanism for measuring and reporting the
	number of persons who obtained health insurance or other health
	benefits coverage as a result of the program.
	(c) The commission shall implement the premium payment
	assistance program developed under Subsection (b), subject to
	availability of money in the fund for that purpose.
	Sec. 531.508. INFRASTRUCTURE IMPROVEMENTS. (a) Except as
	otherwise provided by the terms of a waiver authorized by Section
	531.502 and subject to Subsection (c), money in the fund 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 fund 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) If the executive commissioner of the Health and Human
	Services Commission obtains federal approval for a waiver under
	Section 531.502, Government Code, as added by this section, the
	executive commissioner shall submit a report to the Legislative
	Budget Board that outlines the components and terms of that waiver
	as soon as possible after federal approval is granted.
	SECTION 8. (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.
	(c) The commission shall notify the attorney general of a
	hospital's failure to report the cost of uncompensated care on or
	before the date the report was due in accordance with rules adopted
	under Subsection (a)(3). On receipt of the notice, the attorney
	general shall impose an administrative penalty on the hospital in
	the amount of $1,000 for each day after the date the report was due
	that the hospital has not submitted the report, not to exceed
	$10,000.
	(d) If the commission determines through the procedures
	adopted under Subsection (b) that a hospital submitted a report
	with incomplete or inaccurate information, the commission shall
	notify the hospital of the specific information the hospital must
	submit and prescribe a date by which the hospital must provide that
	information. If the hospital fails to submit the specified
	information on or before the date prescribed by the commission, the
	commission shall notify the attorney general of that failure. On
	receipt of the notice, the attorney general shall impose an
	administrative penalty on the hospital in an amount not to exceed
	$10,000. In determining the amount of the penalty to be imposed,
	the attorney general shall consider:
	(1) the seriousness of the violation;
	(2) whether the hospital had previously committed a
	violation; and
	(3) the amount necessary to deter the hospital from
	committing future violations.
	(e) A report by the commission to the attorney general under
	Subsection (c) or (d) must state the facts on which the commission
	based its determination that the hospital failed to submit a report
	or failed to completely and accurately report information, as
	applicable.
	(f) The attorney general shall give written notice of the
	commission's report to the hospital alleged to have failed to
	comply with a requirement. The notice must include a brief summary
	of the alleged violation, a statement of the amount of the
	administrative penalty to be imposed, and a statement of the
	hospital's right to a hearing on the alleged violation, the amount
	of the penalty, or both.
	(g) Not later than the 20th day after the date the notice is
	sent under Subsection (f), the hospital must make a written request
	for a hearing or remit the amount of the administrative penalty to
	the attorney general. Failure to timely request a hearing or remit
	the amount of the administrative penalty results in a waiver of the
	right to a hearing under this section. If the hospital timely
	requests a hearing, the attorney general shall conduct the hearing
	in accordance with Chapter 2001, Government Code. If the hearing
	results in a finding that a violation has occurred, the attorney
	general shall:
	(1) provide to the hospital written notice of:
	(A) the findings established at the hearing; and
	(B) the amount of the penalty; and
	(2) enter an order requiring the hospital to pay the
	amount of the penalty.
	(h) Not later than the 30th day after the date the hospital
	receives the order entered by the attorney general under Subsection
	(g), the hospital shall:
	(1) pay the amount of the administrative penalty;
	(2) remit the amount of the penalty to the attorney
	general for deposit in an escrow account and file a petition for
	judicial review contesting the occurrence of the violation, the
	amount of the penalty, or both; or
	(3) without paying the amount of the penalty, file a
	petition for judicial review contesting the occurrence of the
	violation, the amount of the penalty, or both and file with the
	court a sworn affidavit stating that the hospital is financially
	unable to pay the amount of the penalty.
	(i) The attorney general's order is subject to judicial
	review as a contested case under Chapter 2001, Government Code.
	(j) If the hospital paid the penalty and on review the court
	does not sustain the occurrence of the violation or finds that the
	amount of the administrative penalty should be reduced, the
	attorney general shall remit the appropriate amount to the hospital
	not later than the 30th day after the date the court's judgment
	becomes final.
	(k) If the court sustains the occurrence of the violation:
	(1) the court:
	(A) shall order the hospital to pay the amount of
	the administrative penalty; and
	(B) may award to the attorney general the
	attorney's fees and court costs incurred by the attorney general in
	defending the action; and
	(2) the attorney general shall remit the amount of the
	penalty to the comptroller for deposit in the general revenue fund.
	(l) If the hospital does not pay the amount of the
	administrative penalty after the attorney general's order becomes
	final for all purposes, the attorney general may enforce the
	penalty as provided by law for legal judgments.
	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 January 1,
	2009.
	(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 the
	Medicaid disproportionate share methodology is consistent with the
	standardized adjustments to uncompensated care costs described by
	Subdivision (4), Subsection (g), Section 531.552, Government Code,
	as added by this section, and adopted by the executive
	commissioner.
	SECTION 9. Chapter 531, Government Code, is amended by
	adding Subchapter P to read as follows:
	SUBCHAPTER P. PHYSICIAN-CENTERED NURSING FACILITY MODEL
	DEMONSTRATION PROJECT
	Sec. 531.601. DEFINITIONS. In this subchapter:
	(1) "Nursing facility" has the meaning assigned by
	Section 242.301, Health and Safety Code.
	(2) "Project" means the physician-centered nursing
	facility model demonstration project implemented under this
	subchapter.
	Sec. 531.602. PHYSICIAN-CENTERED NURSING FACILITY MODEL
	DEMONSTRATION PROJECT. (a) The commission may develop and
	implement a demonstration project to determine whether paying an
	enhanced Medicaid reimbursement rate to a nursing facility that
	provides continuous, on-site oversight of residents by physicians
	specializing in geriatric medicine results in:
	(1) improved overall health of residents of that
	facility; and
	(2) cost savings resulting from a reduction of acute
	care hospitalization and pharmaceutical costs.
	(b) In developing the project, the commission may consider
	similar physician-centered nursing facility models implemented in
	other states to determine the most cost-effective measures to
	implement in the project under this subchapter.
	(c) The commission may consider whether the project could
	involve the Medicare program, subject to federal law and approval.
	Sec. 531.603. REPORT. (a) If the commission develops and
	implements the project, the commission shall, not later than
	December 1, 2008, submit a preliminary status report to the
	governor, the lieutenant governor, the speaker of the house of
	representatives, and the chairs of the standing committees of the
	senate and house of representatives having primary jurisdiction
	over the Medicaid program. The report must:
	(1) describe the project, including the
	implementation and performance of the project during the preceding
	year; and
	(2) evaluate the operation of the project.
	(b) If the commission develops and implements the project,
	the commission shall submit a subsequent report to the persons
	listed in Subsection (a) preceding the regular session of the 82nd
	Legislature. The report must make recommendations regarding:
	(1) the continuation or expansion of the project, to
	be determined based on the cost-effectiveness of the project; and
	(2) if the commission recommends expanding the
	project, any necessary statutory or budgetary changes.
	Sec. 531.604. EXPIRATION. This subchapter expires
	September 1, 2011.
	SECTION 10. Subchapter A, Chapter 533, Government Code, is
	amended by adding Section 533.0051 to read as follows:
	Sec. 533.0051. PERFORMANCE MEASURES AND INCENTIVES FOR
	VALUE-BASED CONTRACTS. (a) The commission shall establish
	outcome-based performance measures and incentives to include in
	each contract between a health maintenance organization and the
	commission for the provision of health care services to recipients
	that is procured and managed under a value-based purchasing model.
	The performance measures and incentives must be designed to
	facilitate and increase recipients' access to appropriate health
	care services.
	(b) Subject to Subsection (c), the commission shall include
	the performance measures and incentives established under
	Subsection (a) in each contract described by that subsection in
	addition to all other contract provisions required by this chapter.
	(c) The commission may use a graduated approach to including
	the performance measures and incentives established under
	Subsection (a) in contracts described by that subsection to ensure
	incremental and continued improvements over time.
	(d) Subject to Subsection (f), the commission shall assess
	the feasibility and cost-effectiveness of including provisions in a
	contract described by Subsection (a) that require the health
	maintenance organization to provide to the providers in the
	organization's provider network pay-for-performance opportunities
	that support quality improvements in the care of Medicaid
	recipients. Pay-for-performance opportunities may include
	incentives for providers to provide care after normal business
	hours and to participate in the early and periodic screening,
	diagnosis, and treatment program and other activities that improve
	Medicaid recipients' access to care. If the commission determines
	that the provisions are feasible and may be cost-effective, the
	commission shall develop and implement a pilot program in at least
	one health care service region under which the commission will
	include the provisions in contracts with health maintenance
	organizations offering managed care plans in the region.
	(e) The commission shall post the financial statistical
	report on the commission's web page in a comprehensive and
	understandable format.
	(f) The commission shall, to the extent possible, base an
	assessment of feasibility and cost-effectiveness under Subsection
	(d) on publicly available, scientifically valid, evidence-based
	criteria appropriate for assessing the Medicaid population.
	(g) In performing the commission's duties under Subsection
	(d) with respect to assessing feasibility and cost-effectiveness,
	the commission may consult with physicians, including those with
	expertise in quality improvement and performance measurement, and
	hospitals.
	SECTION 11. (a) Subsection (c), Section 533.012,
	Government Code, is amended to read as follows:
	(c) The commission's office of investigations and
	enforcement shall review the information submitted under this
	section as appropriate in the investigation of fraud in the
	Medicaid managed care program. [~~The comptroller may review the~~
	~~information in connection with the health care fraud study~~
	~~conducted by the comptroller.~~]
	(b) Section 403.028, Government Code, is repealed.
	SECTION 12. (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 section, 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 section 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 13. (a) Subtitle C, Title 2, Health and Safety
	Code, is amended by adding Chapter 75 to read as follows:
	CHAPTER 75. REGIONAL OR LOCAL HEALTH CARE PROGRAMS FOR EMPLOYEES OF
	SMALL EMPLOYERS
	SUBCHAPTER A. GENERAL PROVISIONS
	Sec. 75.001. PURPOSE. The purpose of this chapter is to:
	(1) improve the health of employees of small employers
	and their families by improving the employees' access to health
	care and by reducing the number of those employees who are
	uninsured;
	(2) reduce the likelihood that those employees and
	their families will require services from state-funded entitlement
	programs such as Medicaid;
	(3) contribute to economic development by helping
	small businesses remain competitive with a healthy workforce and
	health care benefits that will attract employees; and
	(4) encourage innovative solutions for providing and
	funding health care services and benefits.
	Sec. 75.002. DEFINITIONS. In this chapter:
	(1) "Employee" means an individual employed by an
	employer. The term includes a partner of a partnership and the
	proprietor of a sole proprietorship.
	(2) "Governing body" means:
	(A) the commissioners courts of the counties
	participating in a regional health care program;
	(B) the commissioners court of a county
	participating in a local health care program; or
	(C) the governing body of the joint council,
	nonprofit entity exempt from federal taxation, or other entity that
	operates a regional or local health care program.
	(3) "Local health care program" means a local health
	care program operating in one county and established for the
	benefit of the employees of small employers under Subchapter B.
	(4) "Regional health care program" means a regional
	health care program operating in two or more counties and
	established for the benefit of the employees of small employers
	under Subchapter B.
	(5) "Small employer" means a person who employed an
	average of at least two employees but not more than 50 employees on
	business days during the preceding calendar year and who employs at
	least two employees on the first day of the plan year.
	[Sections 75.003-75.050 reserved for expansion]
	SUBCHAPTER B. REGIONAL OR LOCAL HEALTH CARE PROGRAM
	Sec. 75.051. ESTABLISHMENT OF PROGRAM; MULTICOUNTY
	COOPERATION. (a) The commissioners court of a county may, by
	order, establish or participate in a local health care program
	under this subchapter.
	(b) The commissioners courts of two or more counties may, by
	joint order, establish or participate in a regional health care
	program under this subchapter.
	Sec. 75.052. GOVERNANCE OF PROGRAM. (a) A regional health
	care program may be operated subject to the direct governance of the
	commissioners courts of the participating counties. A local health
	care program may be operated subject to the direct governance of the
	commissioners court of the participating county. A regional or
	local health care program may be operated by a joint council,
	tax-exempt nonprofit entity, or other entity that:
	(1) operates the program under a contract with the
	commissioners court or courts, as applicable; or
	(2) is an entity in which the county or counties
	participate or that is established or designated by the
	commissioners court or courts, as applicable, to operate the
	program.
	(b) In selecting an entity described by Subsection (a)(1) or
	(2) to operate a regional or local health care program, the
	commissioners court or courts, as applicable, shall require, to the
	extent possible, that the entity be authorized under federal law to
	accept donations on a basis that is tax-deductible or otherwise
	tax-advantaged for the contributor.
	Sec. 75.053. OPERATION OF PROGRAM. A regional or local
	health care program provides health care services or benefits to
	the employees of participating small employers who are located
	within the boundaries of the participating county or counties, as
	applicable. A program may also provide services or benefits to the
	dependents of those employees.
	Sec. 75.054. PARTICIPATION BY SMALL EMPLOYERS; SHARE OF
	COST. Subject to Section 75.153, the governing body may establish
	criteria for participation in a regional or local health care
	program by small employers, the employees of the small employers,
	and their dependents. The criteria must require that participating
	employers and participating employees pay a share of the premium or
	other cost of the program.
	Sec. 75.055. ADDITIONAL FUNDING. (a) A governing body may
	accept and use state money made available through an appropriation
	from the general revenue fund or a gift, grant, or donation from any
	source to operate the regional or local health care program and to
	provide services or benefits under the program.
	(b) A governing body may apply for and receive funding from
	the health opportunity pool trust fund under Subchapter D.
	(b-1) A governing body may apply for and receive a grant
	under Subchapter E to support a regional or local health care
	program if money is appropriated for that purpose. This subsection
	expires September 1, 2009.
	(c) A governing body shall actively solicit gifts, grants,
	and donations to:
	(1) fund services and benefits provided under the
	regional or local health care program; and
	(2) reduce the cost of participation in the program
	for small employers and their employees.
	[Sections 75.056-75.100 reserved for expansion]
	SUBCHAPTER C. HEALTH CARE SERVICES AND BENEFITS
	Sec. 75.101. ALTERNATIVE PROGRAMS AUTHORIZED; PROGRAM
	OBJECTIVES. In developing a regional or local health care program,
	a governing body may provide health care services or benefits as
	described by this subchapter or may develop another type of program
	to accomplish the purposes of this chapter. A regional or local
	health care program must be developed, to the extent practicable,
	to:
	(1) reduce the number of individuals without health
	benefit plan coverage within the boundaries of the participating
	county or counties;
	(2) address rising health care costs and reduce the
	cost of health care services or health benefit plan coverage for
	small employers and their employees within the boundaries of the
	participating county or counties;
	(3) promote preventive care and reduce the incidence
	of preventable health conditions, such as heart disease, cancer,
	and diabetes and low birth weight in infants;
	(4) promote efficient and collaborative delivery of
	health care services;
	(5) serve as a model for the innovative use of health
	information technology to promote efficient delivery of health care
	services, reduce health care costs, and improve the health of the
	community; and
	(6) provide fair payment rates for health care
	providers.
	Sec. 75.102. HEALTH BENEFIT PLAN COVERAGE. (a) A regional
	or local health care program may provide health care benefits to the
	employees of small employers by purchasing or facilitating the
	purchase of health benefit plan coverage for those employees from a
	health benefit plan issuer, including coverage under:
	(1) a small employer health benefit plan offered under
	Chapter 1501, Insurance Code;
	(2) a standard health benefit plan offered under
	Chapter 1507, Insurance Code; or
	(3) any other health benefit plan available in this
	state.
	(b) The governing body may form one or more cooperatives
	under Subchapter B, Chapter 1501, Insurance Code.
	(c) Notwithstanding Chapter 1251, Insurance Code, an
	insurer may issue a group accident and health insurance policy,
	including a group contract issued by a group hospital service
	corporation, to cover the employees of small employers
	participating in a regional or local health care program. The group
	policyholder of a policy issued in accordance with this subsection
	is the governing body or the designee of the governing body.
	(d) A health maintenance organization may issue a health
	care plan to cover the employees of small employers participating
	in a regional or local health care program. The group contract
	holder of a contract issued in accordance with this subsection is
	the governing body or the designee of the governing body.
	Sec. 75.103. OTHER HEALTH BENEFIT PLANS OR PROGRAMS. To the
	extent authorized by federal law, the governing body may establish
	or facilitate the establishment of self-funded health benefit plans
	or may facilitate the provision of health benefit coverage through
	health savings accounts and high-deductible health plans.
	Sec. 75.104. HEALTH CARE SERVICES. (a) A regional or
	local health care program may contract with health care providers
	within the boundaries of the participating county or counties to
	provide health care services directly to the employees of
	participating small employers and the dependents of those
	employees.
	(b) A regional or local health care program shall allow any
	individual who receives state premium assistance to buy into the
	health benefit plan offered by the regional or local health care
	program.
	(c) A governing body that operates a regional or local
	health care program under this section may require that
	participating employees and dependents obtain health care services
	only from health care providers that contract to provide those
	services under the program and may limit the health care services
	provided under the program to services provided within the
	boundaries of the participating county or counties.
	(d) A governing body operating a regional or local health
	care program operated under this section is not an insurer or health
	maintenance organization and the program is not subject to
	regulation by the Texas Department of Insurance.
	[Sections 75.105-75.150 reserved for expansion]
	SUBCHAPTER D. TEXAS HEALTH OPPORTUNITY POOL FUNDS
	Sec. 75.151. DEFINITION. In this subchapter, "health
	opportunity pool trust fund" means the trust fund established under
	Subchapter N, Chapter 531, Government Code.
	Sec. 75.152. FUNDING AUTHORIZED. Notwithstanding any other
	law, a regional or local health care program may apply for funding
	from the health opportunity pool trust fund and the fund may provide
	funding in accordance with this subchapter.
	Sec. 75.153. ELIGIBILITY FOR FUNDS; STATEWIDE ELIGIBILITY
	CRITERIA. To be eligible for funding from money in the health
	opportunity pool trust fund, a regional or local health care
	program must:
	(1) comply with any requirement imposed under the
	waiver obtained under Section 531.502, Government Code, including,
	to the extent applicable, any requirement that health care benefits
	or services provided under the program be provided in accordance
	with statewide eligibility criteria; and
	(2) provide health care benefits or services under the
	program to a person receiving premium payment assistance for health
	benefits coverage through a program established under Section
	531.507, Government Code, regardless of whether the person is an
	employee, or dependent of an employee, of a small employer.
	[Sections 75.154-75.200 reserved for expansion]
	SUBCHAPTER E. GRANTS FOR DEMONSTRATION PROJECTS
	Sec. 75.201. DEFINITIONS. In this subchapter:
	(1) "Commission" means the Health and Human Services
	Commission.
	(2) "Executive commissioner" means the executive
	commissioner of the commission.
	Sec. 75.202. GRANT PROGRAM. (a) The executive
	commissioner may establish a grant program to support the initial
	establishment and operation of one or more regional or local health
	care programs as demonstration projects, subject to the
	appropriation of money for this purpose.
	(b) In selecting grant recipients, the executive
	commissioner shall consider the extent to which the regional or
	local health care program proposed by the applicant accomplishes
	the purposes of this chapter and meets the objectives established
	under Section 75.101.
	(c) The commission shall establish performance objectives
	for a grant recipient and shall monitor the performance of the grant
	recipient.
	Sec. 75.203. REVIEW OF DEMONSTRATION PROJECT; REPORT. Not
	later than December 1, 2008, the commission shall complete a review
	of each regional or local health care program that receives a grant
	under this subchapter and shall submit to the governor, the
	lieutenant governor, and the speaker of the house of
	representatives a report that includes:
	(1) an evaluation of the success of regional and local
	health care programs in accomplishing the purposes of this chapter;
	and
	(2) the commission's recommendations for any
	legislation needed to facilitate or improve regional and local
	health care programs.
	Sec. 75.204. EXPIRATION. This subchapter expires September
	1, 2009.
	(b) 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
	SECTION 14. (a) Subsection (a), Section 773.004, Health
	and Safety Code, is amended to read as follows:
	(a) This chapter does not apply to:
	(1) [~~a ground transfer vehicle and staff used to~~
	~~transport a patient who is under a physician's care between medical~~
	~~facilities or between a medical facility and a private residence,~~
	~~unless it is medically necessary to transport the patient using a~~
	~~stretcher;~~
	[~~(2)~~] air transfer that does not advertise as an
	ambulance service and that is not licensed by the department;
	(2) [~~(3)~~] the use of ground or air transfer vehicles
	to transport sick or injured persons in a casualty situation that
	exceeds the basic vehicular capacity or capability of emergency
	medical services providers in the area;
	(3) [~~(4)~~] an industrial ambulance; or
	(4) [~~(5)~~] a physician, registered nurse, or other
	health care practitioner licensed by this state unless the health
	care practitioner staffs an emergency medical services vehicle
	regularly.
	(b) Section 773.041, Health and Safety Code, is amended by
	adding Subsection (a-1) to read as follows:
	(a-1) A person may not transport a patient by stretcher in a
	vehicle unless the person holds a license as an emergency medical
	services provider issued by the department in accordance with this
	chapter. For purposes of this subsection, "person" means an
	individual, corporation, organization, government, governmental
	subdivision or agency, business, trust, partnership, association,
	or any other legal entity.
	(c) Not later than May 1, 2008, the executive commissioner
	of the Health and Human Services Commission shall adopt the rules
	necessary to implement the changes in law made by this section to
	Chapter 773, Health and Safety Code.
	SECTION 15. Subchapter B, Chapter 32, Human Resources Code,
	is amended by adding Section 32.0214 to read as follows:
	Sec. 32.0214. DESIGNATIONS OF PRIMARY CARE PROVIDER BY
	CERTAIN RECIPIENTS. (a) If the department determines that it is
	cost-effective and feasible and subject to Subsection (b), the
	department shall require each recipient of medical assistance to
	designate a primary care provider with whom the recipient will have
	a continuous, ongoing professional relationship and who will
	provide and coordinate the recipient's initial and primary care,
	maintain the continuity of care provided to the recipient, and
	initiate any referrals to other health care providers.
	(b) A recipient who receives medical assistance through a
	Medicaid managed care model or arrangement under Chapter 533,
	Government Code, that requires the designation of a primary care
	provider shall designate the recipient's primary care provider as
	required by that model or arrangement.
	SECTION 16. Section 32.024, Human Resources Code, is
	amended by adding Subsection (y-1) to read as follows:
	(y-1) A woman who receives a breast or cervical cancer
	screening service under Title XV of the Public Health Service Act
	(42 U.S.C. Section 300k et seq.) and who otherwise meets the
	eligibility requirements for medical assistance for treatment of
	breast or cervical cancer as provided by Subsection (y) is eligible
	for medical assistance under that subsection, regardless of whether
	federal Medicaid matching funds are available for that medical
	assistance. A screening service of a type that is within the scope
	of screening services under that title is considered to be provided
	under that title regardless of whether the service was provided by a
	provider who receives or uses funds under that title.
	SECTION 17. Subchapter B, Chapter 32, Human Resources Code,
	is amended by adding Section 32.02471 to read as follows:
	Sec. 32.02471. MEDICAL ASSISTANCE FOR CERTAIN FORMER FOSTER
	CARE ADOLESCENTS ENROLLED IN HIGHER EDUCATION. (a) In this
	section, "independent foster care adolescent" has the meaning
	assigned by Section 32.0247.
	(b) The department shall provide medical assistance to a
	person who:
	(1) is 21 years of age or older but younger than 23
	years of age;
	(2) would be eligible to receive assistance as an
	independent foster care adolescent under Section 32.0247 if the
	person were younger than 21 years of age; and
	(3) is enrolled in an institution of higher education,
	as defined by Section 61.003(8), Education Code, or a private or
	independent institution of higher education, as defined by Section
	61.003(15), Education Code, that is located in this state and is
	making satisfactory academic progress as determined by the
	institution.
	SECTION 18. 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. 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 an 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 voluntarily opt out of
	receiving services through the medical assistance program and
	enroll in the group health benefit 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 total estimated Medicaid costs for the
	individual, as determined by the executive commissioner, the
	individual shall pay the difference between the required premiums
	and those estimated costs. The individual shall also 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. Subject to Subsection (j-1), enrollment [~~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.
	(j-1) An individual described by Subsection (e-1) who
	enrolls in a group health benefit plan is not ineligible for
	community-based services provided under a Section 1915(c) waiver
	program or another federal waiver program solely based on the
	individual's enrollment in the group health benefit plan, and the
	individual may receive those services if the individual is
	otherwise eligible for the program. The individual is otherwise
	limited to the health benefits coverage provided under the health
	benefit plan in which the individual is enrolled, and the
	individual may not receive any benefits or services under the
	medical assistance program other than the premium payment as
	provided by Subsection (f-1) and, if applicable, waiver program
	services described by this subsection.
	(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 commission, in consultation with the Texas
	Department of Insurance, shall provide training to agents who hold
	a general life, accident, and health license under Chapter 4054,
	Insurance Code, regarding the health insurance premium payment
	reimbursement program and the eligibility requirements for
	participation in the program. Participation in a training program
	established under this subsection is voluntary, and a general life,
	accident, and health agent who successfully completes the training
	is entitled to receive continuing education credit under Subchapter
	B, Chapter 4004, Insurance Code, in accordance with rules adopted
	by the commissioner of insurance.
	(m) The commission may pay a referral fee, in an amount
	determined by the commission, to each general life, accident, and
	health agent who, after completion of the training program
	established under Subsection (l), successfully refers an eligible
	individual to the commission for enrollment in a [~~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 commission shall develop procedures by which an
	individual described by Subsection (e-1) who enrolls in a group
	health benefit plan may, at the individual's option, resume
	receiving benefits and services under the medical assistance
	program instead of the group health benefit plan.
	(o) The commission shall develop procedures which ensure
	that, prior to allowing an individual described by Subsection (e-1)
	to enroll in a group health benefit plan or allowing the parent or
	caretaker of an individual described by Subsection (e-1) under the
	age of 21 to enroll that child in a group health benefit plan:
	(1) the individual must receive counseling informing
	them that for the period in which the individual is enrolled in the
	group health benefit plan:
	(A) the individual shall be limited to the health
	benefits coverage provided under the health benefit plan in which
	the individual is enrolled;
	(B) the individual may not receive any benefits
	or services under the medical assistance program other than the
	premium payment as provided by Subsection (f-1);
	(C) the individual shall pay the difference
	between the required premiums and the premium payment as provided
	by Subsection (f-1) and shall also pay all deductibles, copayments,
	coinsurance, and other cost-sharing obligations imposed on the
	individual under the group health benefit plan; and
	(D) the individual may, at the individual's
	option through procedures developed by the commission, resume
	receiving benefits and services under the medical assistance
	program instead of the group health benefit plan; and
	(2) the individual must sign and the commission shall
	retain a copy of a waiver indicating the individual has provided
	informed consent.
	(p) The executive commissioner [~~department~~] shall adopt
	rules as necessary to implement this section.
	SECTION 19. (a) Section 32.058, Human Resources Code, is
	amended to read as follows:
	Sec. 32.058. LIMITATION ON MEDICAL ASSISTANCE IN CERTAIN
	ALTERNATIVE COMMUNITY-BASED CARE SETTINGS. (a) In this section,
	"medical assistance waiver program" means a program administered by
	the Department of Aging and Disability Services, other than the
	Texas home living program, that provides services under a waiver
	granted in accordance with 42 U.S.C. Section 1396n(c)[:
	[~~(1)~~ ~~"Institution" means a nursing facility or an~~
	~~ICF-MR facility.~~
	[~~(2) "Medical assistance waiver program" means:~~
	[~~(A) the community-based alternatives program;~~
	[~~(B)~~ ~~the community living assistance and support~~
	~~services program;~~
	[~~(C)~~ ~~the deaf-blind/multiple disabilities~~
	~~program;~~
	[~~(D) the consolidated waiver pilot program; or~~
	[~~(E) the medically dependent children program~~].
	(b) Except as provided by Subsection (c), [or] (d), (e), or
	(f), the department may not provide services under a medical
	assistance waiver program to a person [~~receiving medical~~
	~~assistance~~] if the projected cost of providing those services over
	a 12-month period exceeds the individual cost limit specified in
	the medical assistance waiver program.
	(c) The department shall continue to provide services under
	a medical assistance waiver program to a person who was [is]
	receiving those services on September 1, 2005, at a cost that
	exceeded [~~exceeds~~] the individual cost limit specified in the
	medical assistance waiver program, if continuation of those
	services:
	(1) is necessary for the person to live in the most
	integrated setting appropriate to the needs of the person; and
	(2) does not affect the department's compliance with
	the federal average per capita expenditure requirement
	[~~cost-effectiveness and efficiency requirements~~] of the medical
	assistance waiver program under 42 U.S.C. Section [~~Sections~~
	~~1396n(b) and~~] 1396n(c)(2)(D).
	(d) The department may continue to provide services under a
	medical assistance waiver program, other than the home and
	community-based services program, to a person who is ineligible to
	receive those services under Subsection (b) and to whom Subsection
	(c) does not apply if:
	(1) the projected cost of providing those services to
	the person under the medical assistance waiver program over a
	12-month period does not exceed 133.3 percent of the individual
	cost limit specified in the medical assistance waiver program; and
	(2) continuation of those services does not affect the
	department's compliance with the federal average per capita
	expenditure requirement [~~cost-effectiveness and efficiency~~
	~~requirements~~] of the medical assistance waiver program under 42
	U.S.C. Section [~~Sections 1396n(b) and~~] 1396n(c)(2)(D).
	(e) The department may exempt a person from the cost limit
	established under Subsection (d)(1) for a medical assistance waiver
	program if the department determines that:
	(1) the person's health and safety cannot be protected
	by the services provided within the cost limit established for the
	program under that subdivision; and
	(2) there is no available living arrangement, other
	than one provided through the program or another medical assistance
	waiver program, in which the person's health and safety can be
	protected, as evidenced by:
	(A) an assessment conducted by clinical staff of
	the department; and
	(B) supporting documentation, including the
	person's medical and service records.
	(f) The department may continue to provide services under
	the home and community-based services program to a person who is
	ineligible to receive those services under Subsection (b) and to
	whom Subsection (c) does not apply if the department makes, with
	regard to the person's receipt of services under the home and
	community-based services program, the same determinations required
	by Subsections (e)(1) and (2) in the same manner provided by
	Subsection (e) and determines that continuation of those services
	does not affect:
	(1) the department's compliance with the federal
	average per capita expenditure requirement of the home and
	community-based services program under 42 U.S.C. Section
	1396n(c)(2)(D); and
	(2) any cost-effectiveness requirements provided by
	the General Appropriations Act that limit expenditures for the home
	and community-based services program.
	(g) The executive commissioner of the Health and Human
	Services Commission may adopt rules to implement Subsections (d),
	(e), and (f) [~~under which the department may exempt a person from~~
	~~the cost limit established under Subsection (d)(1)~~].
	(h) If a federal agency determines that compliance with any
	provision in this section would make this state ineligible to
	receive federal funds to administer a program to which this section
	applies, a state agency may, but is not required to, implement that
	provision.
	(b) The changes in law made by this section apply only to a
	person receiving medical assistance on or after the effective date
	of this section, regardless of when eligibility for that assistance
	was determined.
	SECTION 20. 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
	provided through a hospital emergency room to pay a copayment,
	premium payment, or other cost-sharing payment for the high-cost
	medical service if:
	(1) the hospital from which the recipient seeks
	service:
	(A) performs an appropriate medical screening
	and determines that the recipient does not have a condition
	requiring emergency medical services;
	(B) informs the recipient:
	(i) that the recipient does not have a
	condition requiring emergency medical services;
	(ii) that, if the hospital provides the
	nonemergency service, the hospital may require payment of a
	copayment, premium payment, or other cost-sharing payment by the
	recipient in advance; and
	(iii) of the name and address of a
	nonemergency Medicaid provider who can provide the appropriate
	medical service without imposing a cost-sharing payment; and
	(C) offers to provide the recipient with a
	referral to the nonemergency provider to facilitate scheduling of
	the service; and
	(2) after receiving the information and assistance
	described by Subdivision (1) from the hospital, the recipient
	chooses to obtain emergency medical services despite having access
	to medically acceptable, lower-cost medical services.
	(b) The department may not seek a federal waiver or other
	authorization under Subsection (a) that would:
	(1) prevent a Medicaid recipient who has a condition
	requiring emergency medical services from receiving care through a
	hospital emergency room; or
	(2) waive any provision under Section 1867, Social
	Security Act (42 U.S.C. Section 1395dd).
	(c) If the executive commissioner of the Health and Human
	Services Commission adopts a copayment or other cost-sharing
	payment under Subsection (a), the commission may not reduce
	hospital payments to reflect the potential receipt of a copayment
	or other payment from a recipient receiving medical services
	provided through a hospital emergency room.
	SECTION 21. (a) Subchapter B, Chapter 32, Human Resources
	Code, is amended by adding Section 32.072 to read as follows:
	Sec. 32.072. DIRECT ACCESS TO EYE HEALTH CARE SERVICES.
	(a) Notwithstanding any other law, a recipient of medical
	assistance is entitled to:
	(1) select an ophthalmologist or therapeutic
	optometrist who is a medical assistance provider to provide eye
	health care services, other than surgery, that are within the scope
	of:
	(A) services provided under the medical
	assistance program; and
	(B) the professional specialty practice for
	which the ophthalmologist or therapeutic optometrist is licensed
	and credentialed; and
	(2) have direct access to the selected ophthalmologist
	or therapeutic optometrist for the provision of the nonsurgical
	services without any requirement to obtain:
	(A) a referral from a primary care physician or
	other gatekeeper or health care coordinator; or
	(B) any other prior authorization or
	precertification.
	(b) The department may require an ophthalmologist or
	therapeutic optometrist selected as provided by this section by a
	recipient of medical assistance who is otherwise required to have a
	primary care physician or other gatekeeper or health care
	coordinator to forward to the recipient's physician, gatekeeper, or
	health care coordinator information concerning the eye health care
	services provided to the recipient.
	(c) This section may not be construed to expand the scope of
	eye health care services provided under the medical assistance
	program.
	(b) Subchapter A, Chapter 533, Government Code, is amended
	by adding Section 533.0026 to read as follows:
	Sec. 533.0026. DIRECT ACCESS TO EYE HEALTH CARE SERVICES
	UNDER MEDICAID MANAGED CARE MODEL OR ARRANGEMENT.
	(a) Notwithstanding any other law, the commission shall ensure
	that a managed care plan offered by a managed care organization that
	contracts with the commission under this chapter and any other
	Medicaid managed care model or arrangement implemented under this
	chapter allow a Medicaid recipient who receives services through
	the plan or other model or arrangement to, in the manner and to the
	extent required by Section 32.072, Human Resources Code:
	(1) select an in-network ophthalmologist or
	therapeutic optometrist in the managed care network to provide eye
	health care services, other than surgery; and
	(2) have direct access to the selected in-network
	ophthalmologist or therapeutic optometrist for the provision of the
	nonsurgical services.
	(b) This section does not affect the obligation of an
	ophthalmologist or therapeutic optometrist in a managed care
	network to comply with the terms and conditions of the managed care
	plan.
	(c) The changes in law made by Section 533.0026, Government
	Code, as added by this section, 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.
	SECTION 22. Chapter 32, Human Resources Code, is amended by
	adding Subchapter C to read as follows:
	SUBCHAPTER C. ELECTRONIC COMMUNICATIONS
	Sec. 32.101. DEFINITIONS. In this subchapter:
	(1) "Electronic health record" means electronically
	originated and maintained health and claims information regarding
	the health status of an individual that may be derived from multiple
	sources and includes the following core functionalities:
	(A) a patient health and claims information or
	data entry function to aid with medical diagnosis, nursing
	assessment, medication lists, allergy recognition, demographics,
	clinical narratives, and test results;
	(B) a results management function that may
	include computerized laboratory test results, diagnostic imaging
	reports, interventional radiology reports, and automated displays
	of past and present medical or laboratory test results;
	(C) a computerized physician order entry of
	medication, care orders, and ancillary services;
	(D) clinical decision support that may include
	electronic reminders and prompts to improve prevention, diagnosis,
	and management; and
	(E) electronic communication and connectivity
	that allows online communication:
	(i) among physicians and health care
	providers; and
	(ii) among the Health and Human Services
	Commission, the operating agencies, and participating providers.
	(2) "Executive commissioner" means the executive
	commissioner of the Health and Human Services Commission.
	(3) "Health care provider" means a person, other than
	a physician, who is licensed or otherwise authorized to provide a
	health care service in this state.
	(4) "Health information technology" means information
	technology used to improve the quality, safety, or efficiency of
	clinical practice, including the core functionalities of an
	electronic health record, electronic medical record, computerized
	physician or health care provider order entry, electronic
	prescribing, and clinical decision support technology.
	(5) "Operating agency" means a health and human
	services agency operating part of the medical assistance program.
	(6) "Participating provider" means a physician or
	health care provider who is a provider of medical assistance,
	including a physician or health care provider who contracts or
	otherwise agrees with a managed care organization to provide
	medical assistance under this chapter.
	(7) "Physician" means an individual licensed to
	practice medicine in this state under the authority of Subtitle B,
	Title 3, Occupations Code, or a person that is:
	(A) a professional association of physicians
	formed under the Texas Professional Association Law, as described
	by Section 1.008, Business Organizations Code;
	(B) an approved nonprofit health corporation
	certified under Chapter 162, Occupations Code, that employs or
	contracts with physicians to provide medical services;
	(C) a medical and dental unit, as defined by
	Section 61.003, Education Code, a medical school, as defined by
	Section 61.501, Education Code, or a health science center
	described by Subchapter K, Chapter 74, Education Code, that employs
	or contracts with physicians to teach or provide medical services,
	or employs physicians and contracts with physicians in a practice
	plan; or
	(D) a person wholly owned by a person described
	by Paragraph (A), (B), or (C).
	(8) "Recipient" means a recipient of medical
	assistance.
	Sec. 32.102. ELECTRONIC COMMUNICATIONS. (a) To the extent
	allowed by federal law, the executive commissioner may adopt rules
	allowing the Health and Human Services Commission to permit,
	facilitate, and implement the use of health information technology
	for the medical assistance program to allow for electronic
	communication among the commission, the operating agencies, and
	participating providers for:
	(1) eligibility, enrollment, verification procedures,
	and prior authorization for health care services or procedures
	covered by the medical assistance program, as determined by the
	executive commissioner, including diagnostic imaging;
	(2) the update of practice information by
	participating providers;
	(3) the exchange of recipient health care information,
	including electronic prescribing and electronic health records;
	(4) any document or information requested or required
	under the medical assistance program by the Health and Human
	Services Commission, the operating agencies, or participating
	providers; and
	(5) the enhancement of clinical and drug information
	available through the vendor drug program to ensure a comprehensive
	electronic health record for recipients.
	(b) If the executive commissioner determines that a need
	exists for the use of health information technology in the medical
	assistance program and that the technology is cost-effective, the
	Health and Human Services Commission may, for the purposes
	prescribed by Subsection (a):
	(1) acquire and implement the technology; or
	(2) evaluate the feasibility of developing and, if
	feasible, develop, the technology through the use or expansion of
	other systems or technologies the commission uses for other
	purposes, including:
	(A) the technologies used in the pilot program
	implemented under Section 531.1063, Government Code; and
	(B) the health passport developed under Section
	266.006, Family Code.
	(c) The commission:
	(1) must ensure that health information technology
	used under this section complies with the applicable requirements
	of the Health Insurance Portability and Accountability Act;
	(2) may require the health information technology used
	under this section to include technology to extract and process
	claims and other information collected, stored, or accessed by the
	medical assistance program, program contractors, participating
	providers, and state agencies operating any part of the medical
	assistance program for the purpose of providing patient information
	at the location where the patient is receiving care;
	(3) must ensure that a paper record or document is not
	required to be filed if the record or document is permitted or
	required to be filed or transmitted electronically by rule of the
	executive commissioner;
	(4) may provide for incentives to participating
	providers to encourage their use of health information technology
	under this subchapter;
	(5) may provide recipients with a method to access
	their own health information; and
	(6) may present recipients with an option to decline
	having their health information maintained in an electronic format
	under this subchapter.
	(d) The executive commissioner shall consult with
	participating providers and other interested stakeholders in
	developing any proposed rules under this section. The executive
	commissioner shall request advice and information from those
	stakeholders concerning the proposed rules, including advice
	regarding the impact of and need for a proposed rule.
	SECTION 23. (a) Chapter 32, Human Resources Code, is
	amended by adding Subchapter D to read as follows:
	SUBCHAPTER D. ELECTRONIC HEALTH INFORMATION PILOT PROGRAM
	Sec. 32.151. DEFINITIONS. In this subchapter:
	(1) "Electronic health record" means an ambulatory
	electronic health record that is certified by the Certification
	Commission for Healthcare Information Technology or that meets
	other federally approved interoperability standards.
	(2) "Executive commissioner" means the executive
	commissioner of the Health and Human Services Commission.
	(3) "Health information technology" means information
	technology used to improve the quality, safety, and efficiency of
	clinical practice, including the core functionalities of an
	electronic health record, computerized physician order entry,
	electronic prescribing, and clinical decision support technology.
	(4) "Provider" means:
	(A) an individual licensed to practice medicine
	in this state under Subtitle B, Title 3, Occupations Code;
	(B) a professional association of four or fewer
	physicians formed under the Texas Professional Association Law, as
	described by Section 1.008, Business Organizations Code; or
	(C) an advanced practice nurse licensed and
	authorized to practice under Subtitle E, Title 3, Occupations Code.
	(5) "Recipient" means a recipient of medical
	assistance.
	Sec. 32.152. ELECTRONIC HEALTH INFORMATION PILOT PROGRAM.
	The executive commissioner, from money appropriated for this
	purpose, shall develop and implement a pilot program for providing
	health information technology, including electronic health
	records, for use by primary care providers who provide medical
	assistance to recipients.
	Sec. 32.153. PROVIDER PARTICIPATION. For participation in
	the pilot program, the department shall select providers who:
	(1) volunteer to participate in the program;
	(2) are providers of medical assistance, including
	providers who contract or otherwise agree with a managed care
	organization to provide medical assistance under this chapter; and
	(3) demonstrate that at least 40 percent of the
	providers' practice involves the provision of primary care services
	to recipients in the medical assistance program.
	Sec. 32.154. SECURITY OF PERSONALLY IDENTIFIABLE HEALTH
	INFORMATION. (a) Personally identifiable health information of
	recipients enrolled in the pilot program must be maintained in an
	electronic format or technology that meets interoperability
	standards that are recognized by the Certification Commission for
	Healthcare Information Technology or other federally approved
	certification standards.
	(b) The system used to access a recipient's electronic
	health record must be secure and maintain the confidentiality of
	the recipient's personally identifiable health information in
	accordance with applicable state and federal law.
	Sec. 32.155. GIFTS, GRANTS, AND DONATIONS. The department
	may request and accept gifts, grants, and donations from public or
	private entities for the implementation of the pilot program.
	Sec. 32.156. PROTECTED HEALTH INFORMATION. To the extent
	that this subchapter authorizes the use or disclosure of protected
	health information by a covered entity, as those terms are defined
	by the privacy rule of the Administrative Simplification subtitle
	of the Health Insurance Portability and Accountability Act of 1996
	(Pub. L. No. 104-191) contained in 45 C.F.R. Part 160 and 45 C.F.R.
	Part 164, Subparts A and E, the covered entity shall ensure that the
	use or disclosure complies with all applicable requirements,
	standards, or implementation specifications of the privacy rule.
	Sec. 32.157. EXPIRATION OF SUBCHAPTER. This subchapter
	expires September 1, 2011.
	(b) Not later than December 31, 2008, the executive
	commissioner of the Health and Human Services Commission shall
	submit to the governor, lieutenant governor, speaker of the house
	of representatives, presiding officer of the House Committee on
	Public Health, and presiding officer of the Senate Committee on
	Health and Human Services a report regarding the preliminary
	results of the pilot program established under Subchapter D,
	Chapter 32, Human Resources Code, as added by this section, and any
	recommendations regarding expansion of the pilot program,
	including any recommendations for legislation and requests for
	appropriation necessary for the expansion of the pilot program.
	SECTION 24. (a) Subsection (a), Section 1207.002,
	Insurance Code, is amended to read as follows:
	(a) A group health benefit plan issuer shall permit an
	individual who is otherwise eligible for enrollment in the plan to
	enroll in the plan, without regard to any enrollment period
	restriction, on receipt of written notice from the Health and Human
	Services Commission [~~or a designee of the commission stating~~] that
	the individual is:
	(1) a recipient of medical assistance under the state
	Medicaid program and is a participant in the health insurance
	premium payment reimbursement program under Section 32.0422, Human
	Resources Code; or
	(2) a child eligible for [~~enrolled in~~] the state child
	health plan under Chapter 62, Health and Safety Code, and eligible
	to participate [~~is a participant~~] in the health insurance premium
	assistance program under Section 62.059, Health and Safety Code.
	(b) Section 1207.003, Insurance Code, is amended to read as
	follows:
	Sec. 1207.003. EFFECTIVE DATE OF ENROLLMENT. (a) Unless
	enrollment occurs during an established enrollment period,
	enrollment in a group health benefit plan under Section 1207.002
	takes effect on:
	(1) the eligibility enrollment date specified in the
	written notice from the Health and Human Services Commission under
	Section 1207.002(a); or
	(2) the first day of the first calendar month that
	begins at least 30 days after the date written notice or a written
	request is received by the plan issuer under Section 1207.002(a) or
	(b), as applicable.
	(b) Notwithstanding Subsection (a), the individual must
	comply with a waiting period required under the state child health
	plan under Chapter 62, Health and Safety Code, or under the health
	insurance premium assistance program under Section 62.059, Health
	and Safety Code, as applicable.
	(c) Subsection (b), Section 1207.004, Insurance Code, is
	amended to read as follows:
	(b) Notwithstanding any other requirement of a group health
	benefit plan, the plan issuer shall permit an individual who is
	enrolled in the plan under Section 1207.002(a)(2), and any family
	member of the individual enrolled under Section 1207.002(c), to
	terminate enrollment in the plan not later than the 60th day after
	the date on which the individual provides a written request to
	disenroll from the plan because the individual [~~satisfactory proof~~
	~~to the issuer that the child is~~] no longer wishes to participate [a
	~~participant~~] in the health insurance premium assistance program
	under Section 62.059, Health and Safety Code.
	SECTION 25. Subtitle G, Title 8, Insurance Code, is amended
	by adding Chapter 1508 to read as follows:
	CHAPTER 1508. HEALTHY TEXAS PROGRAM
	Sec. 1508.001. STUDY; REPORT. (a) The commissioner shall
	conduct a study concerning a Healthy Texas Program, under which
	small employer health plan coverage would be offered through the
	program to persons who would be eligible for that coverage.
	(b) The study shall include a market analysis to assist in
	identification of underserved segments in the voluntary small
	employer group health benefit plan coverage market in this state.
	(c) The commissioner, using existing resources, may
	contract with actuaries and other experts as necessary to conduct
	the study.
	(d) Not later than November 1, 2008, the commissioner shall
	provide a report to the governor, the lieutenant governor, the
	speaker of the house of representatives, and the members of the
	legislature addressing the results of the study concerning the
	Healthy Texas Program. The report must include an analysis and
	information regarding:
	(1) the advantages and disadvantages of the proposed
	program;
	(2) prospective structure and function of the program
	and its components;
	(3) prospective program design and administration,
	including fundamental operational procedures, powers and duties of
	the commissioner, and powers and duties of the program board of
	directors;
	(4) recommendations for program eligibility criteria
	and minimum standards applicable to group health benefit plans that
	may be included in the program;
	(5) identification of other program requirements or
	restrictions and limitations necessary for successful
	implementation of the program;
	(6) the potential economic impact that the program
	would have on the small employer insurance market in this state;
	(7) the anticipated impact that the program would have
	on the quality of health care provided in this state; and
	(8) recommendations for any statutory changes to
	address implementation of the program.
	Sec. 1508.002. EXPIRATION. This chapter expires September
	1, 2009.
	SECTION 26. (a) The Texas Health Care Policy Council, in
	coordination with the Institute for Demographic and Socioeconomic
	Research at The University of Texas at San Antonio, the Regional
	Center for Health Workforce Studies at the Center for Health
	Economics and Policy of The University of Texas Health Science
	Center at San Antonio, and the Texas Medical Board, shall conduct a
	study regarding increasing:
	(1) the number of medical residency programs and
	medical residents in this state; and
	(2) the number of physicians practicing medical
	specialties.
	(b) The study must:
	(1) examine the feasibility of using a percentage of
	physician licensing fees to increase the number of medical
	residency programs and medical residents in this state;
	(2) put emphasis on, and recommend a plan of action
	for, increasing the number of:
	(A) medical residency programs and medical
	residents in medically underserved areas of this state; and
	(B) physicians practicing medical specialties
	that are underrepresented in this state; and
	(3) determine the number of medical residents that
	obtain a license to practice medicine in this state on completion of
	a medical residency program in this state.
	(c) Not later than December 1, 2008, the Texas Health Care
	Policy Council shall:
	(1) report the results of the study to the governor,
	the lieutenant governor, and the speaker of the house of
	representatives; and
	(2) make available the raw data from the study to the
	governor, the lieutenant governor, the speaker of the house of
	representatives, the House Committee on Public Health, and the
	Senate Committee on Health and Human Services.
	(d) The Texas Health Care Policy Council may accept gifts,
	grants, and donations of any kind from any source for the purposes
	of this section.
	(e) This section expires January 1, 2009.
	SECTION 27. (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:
	(1) 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; and
	(2) the number of individuals in the state who are not
	covered by health insurance or long-term care insurance.
	(c) The committee on health and long-term care insurance
	incentives is composed of:
	(1) the presiding officers of:
	(A) the Senate Committee on Health and Human
	Services;
	(B) the House Committee on Public Health;
	(C) the Senate Committee on State Affairs; 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 of public accounts;
	(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 Subparagraph (ii), Paragraph
	(B), Subdivision (1), Subsection (a), Section 171.101, 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.
	(e-1) The committee shall:
	(1) study and develop recommendations regarding:
	(A) the cost of health care coverage under health
	benefit plans and how to reduce the cost of coverage through the
	following or other methods:
	(i) changes in health benefit plan design
	or scope of services covered;
	(ii) improvements in disease management and
	other utilization review practices by health care providers and
	health benefit plans;
	(iii) reductions in administrative costs
	incurred by health care providers and health benefit plans;
	(iv) improvements in the use of health care
	information technology by health care providers and health benefit
	plans; and
	(v) development of a reinsurance system for
	health care claims in excess of $50,000; and
	(B) the availability of health care coverage
	under health benefit plans and how to expand health care coverage
	through the following or other methods:
	(i) the providing of premium subsidies for
	health benefit plan coverage by the state or local political
	subdivisions, including three-share or multiple-share programs;
	(ii) the inclusion of individuals or
	employees of private employers under state or local political
	subdivision health benefit plans, including the Texas Health
	Insurance Risk Pool;
	(iii) inclusion of family members and
	dependents under a group health benefit plan regardless of age; and
	(iv) requiring vendors of state and local
	political subdivisions to provide health benefit plan coverage for
	their employees and the employee's family and dependents; and
	(2) provide information obtained in studying the
	issues under Subdivision (1) of this subsection to the Health and
	Human Services Commission and the Texas Department of Insurance for
	purposes of developing a health benefits coverage premium payment
	assistance program under Section 531.507, Government Code, as added
	by this Act.
	(f) Not later than September 1, 2008, the committee shall
	submit to the Senate Committee on Health and Human Services, the
	House Committee on Public Health, the Senate Committee on State
	Affairs, 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 28. (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 Health and Human
	Services 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 29. (a) In this section:
	(1) "Child health plan program" means the state child
	health plan program authorized by Chapter 62, Health and Safety
	Code.
	(2) "Medicaid" means the medical assistance program
	provided under Chapter 32, Human Resources Code.
	(b) The Health and Human Services Commission shall conduct a
	study of the feasibility of providing a health passport for:
	(1) children under 19 years of age who are receiving
	Medicaid and are not provided a health passport under another law of
	this state; and
	(2) children enrolled in the child health plan
	program.
	(c) The feasibility study must:
	(1) examine the cost-effectiveness of the use of a
	health passport in conjunction with the coordination of health care
	services under each program;
	(2) identify any barriers to the implementation of the
	health passport developed for each program and recommend strategies
	for the removal of those barriers;
	(3) examine whether the use of a health passport will
	improve the quality of care for children described in Subsection
	(b) of this section; and
	(4) determine the fiscal impact to this state of the
	proposed initiative.
	(d) Not later than January 1, 2009, the Health and Human
	Services Commission shall submit to the governor, lieutenant
	governor, speaker of the house of representatives, and presiding
	officers of each standing committee of the legislature with
	jurisdiction over the commission a written report containing the
	findings of the study and the commission's recommendations.
	(e) This section expires September 1, 2009.
	SECTION 30. (a) The Medicaid Reform Legislative Oversight
	Committee is created to facilitate the reform efforts in Medicaid,
	the process of addressing the issues of uncompensated hospital
	care, and the establishment of programs addressing the uninsured.
	(b) The committee is composed of eight members, as follows:
	(1) four members of the senate, appointed by the
	lieutenant governor not later than October 1, 2007; and
	(2) four members of the house of representatives,
	appointed by the speaker of the house of representatives not later
	than October 1, 2007.
	(c) A member of the committee serves at the pleasure of the
	appointing official.
	(d) The lieutenant governor shall designate a member of the
	committee as the presiding officer.
	(e) A member of the committee may not receive compensation
	for serving on the committee but is entitled to reimbursement for
	travel expenses incurred by the member while conducting the
	business of the committee as provided by the General Appropriations
	Act.
	(f) The committee shall:
	(1) facilitate the design and development of any
	Medicaid waivers needed to affect reform as directed by this Act;
	(2) facilitate a smooth transition from existing
	Medicaid payment systems and benefit designs to the new model of
	Medicaid enabled by waiver or policy change by the Health and Human
	Services Commission;
	(3) meet at the call of the presiding officer; and
	(4) research, take public testimony, and issue reports
	requested by the lieutenant governor or speaker of the house of
	representatives.
	(g) The committee may:
	(1) request reports and other information from the
	Health and Human Services Commission; and
	(2) review the findings of the work group on
	uncompensated hospital care established under Section 531.552,
	Government Code, as added by this Act.
	(h) The committee shall use existing staff of the senate,
	the house of representatives, and the Texas Legislative Council to
	assist the committee in performing its duties under this section.
	(i) Chapter 551, Government Code, applies to the committee.
	(j) The committee shall report to the lieutenant governor
	and speaker of the house of representatives not later than November
	15, 2008. The report must include:
	(1) identification of significant issues that impede
	the transition to a more effective Medicaid program;
	(2) the measures of effectiveness associated with
	changes to the Medicaid program;
	(3) the impact of Medicaid changes on safety net
	hospitals and other significant traditional providers; and
	(4) the impact on the uninsured in Texas.
	(k) This section expires September 1, 2009, and the
	committee is abolished on that date.
	(l) 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 31. (a) In this section:
	(1) "Commission" means the Health and Human Services
	Commission.
	(2) "Department" means the Texas Department of
	Insurance.
	(b) The department and the commission shall jointly study a
	small employer premium assistance program to provide financial
	assistance for the purchase of small employer health benefit plans
	by small employers.
	(c) The study conducted under this section must address:
	(1) options for program funding, including use of
	money in the Texas health opportunity pool trust fund as described
	by Section 531.507, Government Code, as added by this Act;
	(2) coordination with any other premium assistance
	effort operated, under development, or under consideration by
	either agency; and
	(3) recommended program design, including:
	(A) the manner of targeting small employers;
	(B) provisions to discourage employers and
	others from electing to discontinue other private coverage for
	employees;
	(C) a minimum premium, or percentage of premium,
	that a small employer must pay for each eligible employee's
	coverage;
	(D) eligibility requirements for enrollees for
	whom financial assistance is provided to individuals;
	(E) allocation of opportunities for enrollment
	in the program;
	(F) the duration of enrollment in the program and
	requirements for renewal; and
	(G) verification that small employers
	participating in the program use premium assistance to purchase and
	maintain a small employer health benefit plan.
	(d) In conducting the study, the department and the
	commission may consider programs and efforts undertaken by other
	states to provide premium assistance to small employers.
	(e) Not later than November 1, 2008, the department and the
	commission shall jointly submit a report to the legislature. The
	report must summarize the results of the study conducted under this
	section and the recommendations of the department and commission
	and may include recommendations for proposed legislation to
	implement a small employer premium assistance program as described
	by Subsection (b) of this section.
	SECTION 32. (a) Subject to the appropriation of funds for
	these purposes and Subsection (c) of this section, all powers,
	duties, functions, activities, obligations, rights, contracts,
	records, assets, personal property, personnel, and appropriations
	or other money of the Texas Department of Transportation that are
	essential to the administration of the medical transportation
	program, as specified in Section 531.0057, Government Code, as
	added by this Act, are transferred to the Health and Human Services
	Commission.
	(b) A reference in law or an administrative rule to the
	Texas Department of Transportation that relates to the medical
	transportation program means the Health and Human Services
	Commission.
	(c) The Texas Department of Transportation shall take all
	action necessary to provide for the transfer of its contractual
	obligations to administer the medical transportation program, as
	specified in Section 531.0057, Government Code, as added by this
	Act, to the Health and Human Services Commission as soon as possible
	after the effective date of this section but not later than
	September 1, 2008.
	(d) Effective September 1, 2008, Subsection (a), Section
	461.012, Health and Safety Code, is amended to read as follows:
	(a) The commission shall:
	(1) provide for research and study of the problems of
	chemical dependency in this state and seek to focus public
	attention on those problems through public information and
	education programs;
	(2) plan, develop, coordinate, evaluate, and
	implement constructive methods and programs for the prevention,
	intervention, treatment, and rehabilitation of chemical dependency
	in cooperation with federal and state agencies, local governments,
	organizations, and persons, and provide technical assistance,
	funds, and consultation services for statewide and community-based
	services;
	(3) cooperate with and enlist the assistance of:
	(A) other state, federal, and local agencies;
	(B) hospitals and clinics;
	(C) public health, welfare, and criminal justice
	system authorities;
	(D) educational and medical agencies and
	organizations; and
	(E) other related public and private groups and
	persons;
	(4) expand chemical dependency services for children
	when funds are available because of the long-term benefits of those
	services to the state and its citizens;
	(5) sponsor, promote, and conduct educational
	programs on the prevention and treatment of chemical dependency,
	and maintain a public information clearinghouse to purchase and
	provide books, literature, audiovisuals, and other educational
	material for the programs;
	(6) sponsor, promote, and conduct training programs
	for persons delivering prevention, intervention, treatment, and
	rehabilitation services and for persons in the criminal justice
	system or otherwise in a position to identify chemically dependent
	persons and their families in need of service;
	(7) require programs rendering services to chemically
	dependent persons to safeguard those persons' legal rights of
	citizenship and maintain the confidentiality of client records as
	required by state and federal law;
	(8) maximize the use of available funds for direct
	services rather than administrative services;
	(9) consistently monitor the expenditure of funds and
	the provision of services by all grant and contract recipients to
	assure that the services are effective and properly staffed and
	meet the standards adopted under this chapter;
	(10) make the monitoring reports prepared under
	Subdivision (9) a matter of public record;
	(11) license treatment facilities under Chapter 464;
	(12) use funds appropriated to the commission to carry
	out this chapter and maximize the overall state allotment of
	federal funds;
	(13) develop and implement policies that will provide
	the public with a reasonable opportunity to appear before the
	commission and to speak on any issue under the commission's
	jurisdiction;
	(14) establish minimum criteria that peer assistance
	programs must meet to be governed by and entitled to the benefits of
	a law that authorizes licensing and disciplinary authorities to
	establish or approve peer assistance programs for impaired
	professionals;
	(15) adopt rules governing the functions of the
	commission, including rules that prescribe the policies and
	procedures followed by the commission in administering any
	commission programs;
	(16) plan, develop, coordinate, evaluate, and
	implement constructive methods and programs to provide healthy
	alternatives for youth at risk of selling controlled substances;
	(17) submit to the federal government reports and
	strategies necessary to comply with Section 1926 of the federal
	Alcohol, Drug Abuse, and Mental Health Administration
	Reorganization Act, Pub. L. 102-321 (42 U.S.C. Section 300x-26);
	reports and strategies are to be coordinated with appropriate state
	governmental entities; and
	(18) regulate, coordinate, and provide training for
	alcohol awareness courses required under Section 106.115,
	Alcoholic Beverage Code, and may charge a fee for an activity
	performed by the commission under this subdivision[~~; and~~
	[~~(19)~~ ~~contract with the Texas Department of~~
	~~Transportation for the Texas Department of Transportation to assume~~
	~~all responsibilities of the commission relating to the provision of~~
	~~transportation services for clients of eligible programs~~].
	(e) Notwithstanding Subdivision (19), Subsection (a),
	Section 461.012, Health and Safety Code, the Health and Human
	Services Commission shall implement that section only to the extent
	necessary until the commission effects the transfer of the medical
	transportation program, as specified in Section 531.0057,
	Government Code, as added by this Act, to the commission not later
	than September 1, 2008.
	(f) The following sections remain in effect until September
	1, 2008, for the limited purpose of effecting the transfer of the
	medical transportation program, as specified in Section 531.0057,
	Government Code, as added by this Act. The following sections are
	repealed, effective September 1, 2008:
	(1) Subsection (b), Section 531.02412, Government
	Code;
	(2) Subsection (g), Section 461.012, Health and Safety
	Code;
	(3) Subsection (b), Section 533.012, Health and Safety
	Code;
	(4) Subsection (e), Section 22.001, Human Resources
	Code;
	(5) Subsection (f), Section 40.002, Human Resources
	Code;
	(6) Subsection (g), Section 91.021, Human Resources
	Code;
	(7) Subsection (b), Section 101.0256, Human Resources
	Code;
	(8) Subsection (d), Section 111.0525, Human Resources
	Code;
	(9) Section 455.0015, Transportation Code; and
	(10) Section 461.003, Transportation Code.
	SECTION 33. SEVERABILITY. If any provision of this Act is
	held by a court to be invalid, that invalidity does not affect the
	other provisions of this Act, and to this end the provisions of this
	Act are severable.
	SECTION 34. 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 35. Except as otherwise provided by this Act, this
	Act takes effect September 1, 2007.






	______________________________	______________________________
	President of the Senate	Speaker of the House

	I hereby certify that S.B. No. 10 passed the Senate on
	April 17, 2007, by the following vote: Yeas 30, Nays 0;
	May 24, 2007, Senate refused to concur in House amendments and
	requested appointment of Conference Committee; May 25, 2007, House
	granted request of the Senate; May 27, 2007, Senate adopted
	Conference Committee Report by the following vote: Yeas 30,
	Nays 0.


	______________________________
	Secretary of the Senate

	I hereby certify that S.B. No. 10 passed the House, with
	amendments, on May 23, 2007, by the following vote: Yeas 137,
	Nays 9, one present not voting; May 25, 2007, House granted request
	of the Senate for appointment of Conference Committee;
	May 27, 2007, House adopted Conference Committee Report by the
	following vote: Yeas 145, Nays 3, two present not voting.


	______________________________
	Chief Clerk of the House



	Approved:

	______________________________
	Date


	______________________________
	Governor