HBA-NMO H.B. 1398 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1398 By: Coleman Public Health 3/29/1999 Introduced BACKGROUND AND PURPOSE In 1985, the 69th Texas Legislature enacted the Indigent Health Care and Treatment Act to address the problem of medical indigence in Texas and to define the basic indigent health care responsibilities of the counties, public hospitals, and hospital districts. In 1997, a joint interim charge was issued to the House Committees on Public Health and County Affairs to review the law and make recommendations. The committees' interim report concluded that changes in health care delivery, health care financing, and changes in the population of this state, left some situations inadequately addressed. H.B. 1398 authorizes the Texas Department of Health (TDH) to administer and enforce the Indigent Health Care and Treatment Act, widens the scope of mandatory and optional indigent health care services, amends eligibility requirements, modifies state financial assistance to counties, and establishes reporting requirements. This bill also requires TDH to study the current threshold for state assistance, and requires the commissioner of health and human services to establish a regional health care delivery system pilot program in a region of the state. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Health in SECTION 1.02 (Section 61.0055, Health and Safety Code) and SECTION 1.11 (Section 61.0395, Health and Safety Code); and to the commissioner of health and human services in SECTION 4.05 of this bill. SECTION BY SECTION ANALYSIS ARTICLE 1. DELIVERY OF INDIGENT HEALTH CARE BY COUNTIES, PUBLIC HOSPITALS, AND HOSPITAL DISTRICTS SECTION 1.01. Amends Section 61.002, Health and Safety Code, to delete the definition of "AFDC." Makes conforming changes. SECTION 1.02. Amends Subchapter A, Chapter 61, Health and Safety Code, by adding Section 61.0055, as follows: Sec. 61.0055. ADMINISTRATION AND ENFORCEMENT; RULES. Requires the Texas Department of Health (TDH) to administer and enforce this chapter (Indigent Health Care and Treatment Act) and authorizes the Texas Board of Health (board) to adopt rules as necessary to administer and enforce this chapter. SECTION 1.03. Amends Sections 61.006 and 61.007, Health and Safety Code, as follows: Sec. 61.006. STANDARDS AND PROCEDURES. (a) Requires TDH to establish minimum eligibility, rather than eligibility, standards for counties to use in determining eligibility under this chapter. (b) Prohibits the minimum eligibility standards from being more restrictive than the eligibility standards used by the Texas Department of Human Services (DHS) to determine eligibility in the Temporary Assistance for Needy Families (TANF)-Medicaid, rather than AFDC-Medicaid, program. Makes conforming changes. (c) Requires TDH to define the services and establish the payment standards for the categories of services listed in Section 61.0285 (Optional Health Care Services), Health and Safety Code, in addition to Section 61.028(a) (relating to mandatory health care services), Health and Safety Code. Authorizes TDH to consider DHS rules relating to TANF-Medicaid program. Makes conforming changes. (d) Authorizes TDH to establish application, documentation, and verification procedures that are different from and less restrictive than the procedures used to determine eligibility in the TANF-Medicaid program. Deletes language relating to the simplification of standards to provide efficient county administration. Makes conforming changes. (e) Makes conforming changes. (f) Requires TDH to ensure that each person who is entitled to receive federal Social Security Disability Income payments but who is ineligible for Medicare because of a waiting period applicable under federal law will be eligible for assistance under Subchapter B (County Responsibility for Persons Not Residing in an Area Served by a Public Hospital or Hospital District) during the period the person is ineligible for Medicare. Provides that this subsection applies without regard to whether the individual would otherwise meet the basic income and resources requirements for the TANFMedicaid program. (g) Makes conforming changes. (h) Makes conforming changes. (i) Makes conforming changes. Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. Makes conforming changes. SECTION 1.04. Amends Section 61.023(b), Health and Safety Code, to authorize a county, in addition to using a less restrictive standard of eligibility for residents than prescribed by Subsection (a), to credit the services provided to all persons who are eligible residents under that standard toward eligibility for state assistance under this subchapter. SECTION 1.06. Amends Section 61.028, Health and Safety Code, to require a county to provide primary and preventive services designed to meet the needs of the community, in addition to other mandatory health care services. Makes conforming changes. SECTION 1.07. Amends Subchapter B, Chapter 61, Health and Safety Code, by adding Sections 61.0285 and 61.0286, as follows: Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. Authorizes a county, in accordance with TDH rules adopted under 61.006, Health and Safety Code, to provide certain other medically necessary services or supplies that the county determines to be costeffective, in addition to mandatory services provided under Section 61.028, Health and Safety Code. Authorizes the county, if the services are approved by TDH under Section 61.006, Health and Safety Code, to credit the services toward eligibility for state assistance under this subchapter. Authorizes a county to provide health care services that are not specified in this section, or specified services without TDH approval, but prohibits the county from crediting those services toward eligibility for state assistance. Sec. 61.0286. PREMIUM PAYMENTS FOR HEALTH BENEFIT PLAN COVERAGE. Authorizes a county to credit a payment for the purchase of insurance or other health benefit plan coverage made by the county on behalf of an eligible resident under Section 157.006 (Payments for Certain Health Insurance Coverage), Local Government Code, or Section 61.029(a) (relating to the provision of health care services), Health and Safety Code, toward eligibility for state assistance under this subchapter if the county determines that the purchase of the coverage is cost-effective. Authorizes a county that elects to provide health benefit plan coverage under this section to require an eligible resident to contribute to the premium cost, on an income-sliding scale, in accordance with Section 61.005 (Contribution Toward Cost of Assistance), Health and Safety Code. SECTION 1.08. Amends Section 61.034(a), Health and Safety Code, to make conforming changes. SECTION 1.09. Amends Section 61.036(b), Health and Safety Code, to make conforming changes. SECTION 1.10. Amends Sections 61.037, 61.038, and 61.039, Health and Safety Code, to make conforming changes. SECTION 1.11. Amends Subchapter B, Chapter 61, Health and Safety Code, by adding Section 61.0395, as follows: Sec. 61.0395. ADDITIONAL STATE ASSISTANCE FOR OUT-OF-COUNTY TERTIARY CARE. (a) Requires TDH, in addition to care distributed in Section 61.038 (Distribution of Assistance Funds), Health and Safety Code, to distribute assistance to a county that is otherwise eligible for state assistance under this subchapter and that provides a significant amount of tertiary care to eligible residents in a facility located outside of the boundaries of the county (b) Requires the board to adopt rules governing the determination of whether a county is eligible for additional state assistance under this section and the allocation of money appropriated for the purposes of this section. SECTION 1.12. Amends Sections 61.041(a) and (b), Health and Safety Code, to require TDH to establish monthly reporting requirements for all counties required to provide indigent health care under this chapter, including counties seeking state assistance under this chapter and establish procedures necessary to determine if a county is eligible for state assistance. Makes conforming changes. SECTION 1.13. Amends Subchapter B, Chapter 61, Health and Safety Code, by adding Section 61.0415, as follows: Sec. 61.0415. PERFORMANCE STANDARDS FOR PRIMARY AND PREVENTATIVE CARE. Requires TDH, in consultation with the Legislative Budget Board, to develop objective performance standards to measure the level of primary and preventive services provided by a county and establish performance goals for these services. Authorizes TDH, to the extent that money appropriated for state assistance under this subchapter is available for this purpose, to provide grants to counties that meet or exceed the established performance goals. SECTION 1.14. Amends Section 61.054(a), Health and Safety Code, to require a public hospital to provide the mandatory health care, rather than inpatient and outpatient hospital, services a county is required to provide. Makes conforming changes. SECTION 1.15. Amends Section 61.055, Health and Safety Code, to require a hospital district to provide the mandatory health care services a county is required to provide under Section 61.028, Health and Safety Code, together with any other services required under the Texas Constitution and the statute creating the district. SECTION 1.16. Section 157.006, Local Government Code, as follows: Sec. 157.006. New Title: PAYMENTS FOR CERTAIN HEALTH BENEFIT PLAN COVERAGE. Makes conforming changes. SECTION 1.17. Amends Section 531.204(b), Government Code, to provide that the report of the Texas Integrated Enrollment Services (TIES) Legislative Oversight Committee must include an analysis of the feasibility of including indigent health care programs provided by counties, public hospitals, and hospital districts in the TIES, a schedule for inclusion of these programs, and a statement of how TIES may be structured to address the wide variation in information systems used by counties, public hospitals, and hospital districts. SECTION 1.18. Makes application of this Act prospective to January 1, 2000. ARTICLE 2. FEDERAL AUTHORIZATION FOR STATE MEDICAID PROGRAM SECTION 2.01. FEDERAL AUTHORIZATION. Sets forth legislative intent. ARTICLE 3. THRESHOLD FOR STATE ASSISTANCE TO COUNTIES SECTION 3.01. STUDY. Requires TDH to study the threshold for eligibility for state assistance to a county established under Section 61.037 (County Eligibility for State Assistance), Health and Safety Code, and develop a threshold to replace the threshold established under that section that is stated as a formula that reflects a county's fiscal capacity, health care resources, and demographics. SECTION 3.02. WORK GROUP. Requires TDH, in developing the eligibility threshold, to consult with the Legislative Budget Board, the comptroller, and the legislative committees of the house of representatives and senate that have legislative oversight over TDH. Requires TDH to form a work group composed of representatives of the those entities and authorizes TDH to request the cooperation of other persons. SECTION 3.03. REPORT. Requires TDH, not later than December 1, 2000, to submit a written report of the study conducted under this article to the governor, lieutenant governor, and the speaker of the house of representatives. Provides that the report must include the recommendations of the work group with the proposed eligibility threshold. SECTION 3.04. EXPIRATION. Provides that this article expires August 31, 2001. ARTICLE 4. PILOT PROGRAM FOR REGIONAL HEALTH CARE DELIVERY SYSTEM SECTION 4.01. DEFINITIONS. Defines "commissioner," "fund," "hospital district," "pilot program," "public hospital," and "regional advisory committee." SECTION 4.02. PILOT PROGRAM. Requires the commissioner of health and human services (commissioner), not later than January 1, 2000, to establish a regional health care delivery system pilot program (pilot program) in one region of this state. Provides that the pilot program must be established in a region for which a regional advisory committee has been appointed. Prohibits the commissioner from establishing the pilot program in a region unless the governing body of each public hospital, hospital district, and county in the region approves its establishment. Prohibits a county located in the region selected for the pilot program from receiving state assistance under Chapter 61, Health and Safety Code, during the pilot program. SECTION 4.03. REGIONAL HEALTH CARE DELIVERY SYSTEM TRUST FUND. Provides that a regional health care system trust fund (fund) is a trust fund with the comptroller. Provides that the fund is composed of money contributed to the fund under this article. Provides that the fund is not a part of the general funds of this state. Authorizes that the money in the fund be used only to provide health care services through a regional health care delivery system. Sets forth the operating procedures of the fund. SECTION 4.04. REGIONAL HEALTH CARE DELIVERY SYSTEM. Requires the regional advisory committee for the region participating in the pilot program to develop a regional health care delivery system (system). Provides that the system must provide at a minimum the mandatory health care services required by Section 61.028, Health and Safety Code, in each public hospital, hospital district, and a county participating in the pilot program. Provides that the system, in each public hospital, hospital district, and county, must provide comparable services to those provided in the preceding calendar year in that respective entity. Requires the commissioner, on approval of the system by the commissioner, and in consultation with the regional advisory committee, to implement the system in the region. SECTION 4.05. RULES. Authorizes the commissioner to adopt rules as necessary to implement the pilot program. SECTION 4.06. DELEGATION OF POWER OR DUTIES. Authorizes the commissioner to delegate any power or duty of the commissioner under this article to TDH or to the commissioner of public health. SECTION 4.07. REPORT. Requires the commissioner, not later than January 1, 2001, to submit a written report relating to the pilot program to the governor, lieutenant governor, and the speaker of the house of representatives. Sets forth the required composition of the report. SECTION 4.08. EXPIRATION; TERMINATION OF PILOT PROGRAM. Provides that this section expires and the pilot program is terminated August 31, 2001. ARTICLE 5. EFFECTIVE DATE; EMERGENCY SECTION 5.01. Effective date: September 1, 1999. SECTION 5.02. Emergency clause.