HBA-NMO C.S.H.B. 1398 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1398 By: Coleman Public Health 4/19/1999 Committee Report (Substituted) 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 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 the population of this state, left some situations inadequately addressed. C.S.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, provides for a tertiary care facility account, and establishes reporting requirements. This bill also requires TDH make a study relating to basic health care services and 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 Department of Health in SECTION 1.14 (Section 61.037, Health and Safety Code), to the Texas Board of Health in SECTION 2.01 (Sections 46.002 and 46.004, Health and Safety Code), and to the commissioner of health and human services in SECTION 5.02 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 Section 61.004, Health and Safety Code, as follows: Sec. 61.004. New title: RESIDENCE OR ELIGIBILITY DISPUTE. Authorizes the provider of assistance or the governmental entity or hospital district, if a provider and a governmental entity or hospital district cannot agree on whether a person is eligible for assistance under this chapter, in addition to agreeing on the person's residence, to submit the matter to the Texas Department of Health (TDH). Makes a conforming change. SECTION 1.03. Amends Subchapter A, Chapter 61, Health and Safety Code, by adding Section 61.0045, as follows: Sec. 61.0045. INFORMATION NECESSARY TO DETERMINE ELIGIBILITY. (a) Authorizes any provider that delivers health care services to a patient who the provider suspects is an eligible resident of the service area of a county, hospital district, or public hospital under this chapter (Indigent Health Care and Treatment Act) to require the patient to provide any information necessary to establish that the patient is an eligible resident of the applicable service area, and authorize the release of any information relating to the patient to permit the provider to submit a claim to the applicable entity. (b) Requires a county, hospital district, or public hospital that receives information obtained under Subsection (a) to use the information to determining whether the patient to whom services were provided is an eligible resident of the service area of the applicable entity and, if so, requires the entity to pay the claim made by the provider in accordance with this chapter. (c) Authorizes that the application, documentation, and verification procedures established by TDH for counties under Section 61.006 include a standard format for obtaining information under Subsection (a) to facilitate eligibility and residence determinations. SECTION 1.04. 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) Requires the minimum eligibility standards to incorporate a net income eligibility level equal to 25 percent of the federal poverty level based on the federal Office of Management and Budget (OMB) poverty index. Deletes language to make a conforming change. (b-1) Provides that the minimum eligibility standards, effective January 1, 2000, must incorporate a net income eligibility level equal to 22 percent of the federal poverty level based on the OMB poverty index. Provides that this subsection expires December 31, 2000. (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, in accordance with DHS rules relating to the Temporary Assistance for Needy Families (TANF)-Medicaid program. Makes conforming changes. (d) Requires TDH to establish application, documentation, and verification procedures that are consistent with 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) Makes conforming changes. (g) Makes conforming changes. (h) Makes conforming changes. Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. Makes conforming changes. SECTION 1.05. 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 Subchapter B, Chapter 61, Health and Safety Code, by adding Section 61.0235, as follows: Sec. 61.0235. COUNTY JAIL INMATES. (a) Authorizes a county to elect to treat as eligible county residents the inmates of a county jail in the county who satisfy the eligibility requirements applicable in the county under Section 61.023(a)(2) and (3) or (b), but who do not reside in the county or reside in the service area of a public hospital or hospital district in the county. (b) Provides that a county that elects to treat inmates as eligible county residents under Subsection (a) must waive any right to reimbursement from other counties or from public hospitals or hospital districts in whose service areas the inmates reside. (c) Authorizes a county to credit the services provided to each inmate who is treated as an eligible county resident under Subsection (a) toward eligibility for state assistance under this subchapter. SECTION 1.07. Amends Section 61.025(d), Health and Safety Code, to make conforming changes. SECTION 1.08. Amends Section 61.028, Health and Safety Code, as follows: Sec. 61.028. New title: BASIC HEALTH CARE SERVICES. Requires a county to provide basic health care services designed to meet the needs of the community, in addition to other mandatory health care services. Makes conforming changes. SECTION 1.09. Amends Subchapter B, Chapter 61, Health and Safety Code, by adding Sections 61.0285, as follows: Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. (a) 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. (b) Provides that the county must notify TDH of the county's intent to provide services specified by Subsection (a). Authorizes the county, if the services are approved by TDH under Section 61.006, Health and Safety Code, or if TDH fails to notify the county of its disapproval before the 31st day after the date the county notifies TDH of its intent to provide the services, to credit the services toward eligibility for state assistance under this subchapter. (c) Authorizes a county to provide health care services that are not specified in Subsection (a) without actual or constructive approval of the department, but prohibits the county from crediting those services toward eligibility for state assistance. SECTION 1.10. Amends Section 61.031(b), Health and Safety Code, to require that notice of health care services provided be made by telephone not later than the 72nd hour, rather than as soon as possible, after the provider determines the patient's county of residence, and by mail postmarked not later than the fifth, rather than third, working day after the date on which the provider determines the patient's county of residence. SECTION 1.11. Amends Section 61.032(a), Health and Safety Code, to make conforming changes. SECTION 1.12. Amends Section 61.034(a), Health and Safety Code, as follows: Sec. 61.034. New title: PAYMENT STANDARDS FOR HEALTH CARE SERVICES. Deletes "mandatory" from the title. Makes conforming changes. SECTION 1.13. Amends Section 61.036(b), Health and Safety Code, to make conforming changes. SECTION 1.14. Amends Sections 61.037, 61.038, and 61.039, Health and Safety Code, as follows: Sec. 61.037. COUNTY ELIGIBILITY FOR STATE ASSISTANCE. Provides that a county must spend in a state fiscal year at least eight, rather than 10, percent of the county general revenue levy for that year to provide health care service to eligible county residents who qualify for assistance. Authorizes TDH to waive the requirement that a county meet the minimum expenditure level and provide that assistance under this chapter at a lower level determined by TDH if the county demonstrates that it is unable to satisfy the eight percent expenditure level for certain reasons. Requires TDH to adopt rules governing the circumstances under which a waiver is authorized to be granted and the procedures to be used by a county to apply for the waiver. Sets forth procedures regarding TDH determination of waiver and the submission of monthly financial reports by a county. Makes conforming changes. Sec. 61.038. DISTRIBUTION OF ASSISTANCE FUNDS. Provides that state funds provided under this section to a county must be equal to at least 90, rather than 80, percent of the actual payment for the health care services for the county's eligible residents during the remainder of the state fiscal year after the eight percent expenditure level is reached. Makes conforming changes. Sec. 61.039. FAILURE TO PROVIDE STATE ASSISTANCE. Makes a conforming change. SECTION 1.15. Amends Section 61.041, Health and Safety Code, by amending Subsections (a) and (b) and adding Subsection (d), as follows: (a) Makes a conforming change. (b) Makes conforming changes. (d) Requires TDH to establish annual reporting requirements for each county that is required to provide indigent health care under this chapter but that is not required to report. Provides that a county satisfies the annual reporting requirement if the county submits information to TDH as required by law to obtain an annual distribution under the Agreement Regarding Disposition of Settlement Proceeds filed on July 24, 1998, in the United States District Court, Eastern District of Texas, in the case styled The State of Texas v. The American Tobacco Co., et al., No. 5-96CV-91. SECTION 1.16. Amends Section 61.052, Health and Safety Code, by adding Subsection (g), as follows: (g) Authorizes a county that provides health care services to its eligible residents through a hospital established by a board of managers jointly appointed by a county and a municipality that establishes an income and resources standard in accordance with this section (General Eligibility Provisions) to credit the services provided to all persons who are eligible under that standard toward eligibility for state assistance. SECTION 1.17. Amends Section 61.054(a), Health and Safety Code, to require a public hospital to provide the basic health care, rather than inpatient and outpatient hospital, services a county is required to provide. Makes conforming changes. SECTION 1.18. Amends Section 61.055, Health and Safety Code, to require a hospital district to provide the basic 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 1.19. Amends Section 61.058(b), Health and Safety Code, to make conforming changes. SECTION 1.20. Amends Section 61.059(a), Health and Safety Code, to make conforming changes. SECTION 1.21. Amends Section 61.062, Health and Safety Code, to make conforming changes. SECTION 1.22. Amends Section 61.064(a), Health and Safety Code, to make conforming changes. SECTION 1.23. 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 1.24. Amends Chapter 26, Tax Code, by adding Section 26.0441, as follows: Sec. 26.0441. TAX RATE ADJUSTMENT FOR INDIGENT HEALTH CARE. Sets forth the procedure for tax rate adjustment for indigent health care. SECTION 1.25. Makes application of this Article prospective to January 1, 2000. SECTION 1.26. Requires TDH to study the feasibility of requiring or permitting a county, public hospital, and hospital district to issue a uniform identification card to eligible county resident or eligible service area resident, as appropriate, that identifies the resident as eligible for health care assistance under Chapter 61, Health and Safety Code. Requires TDH, not later than December 15, 2000, to report the results of its study to the governor, lieutenant governor, and the speaker of the house of representatives. ARTICLE 2. TERTIARY CARE SECTION 2.01. Amends Subtitle B, Title 2, Health and Safety Code, by adding Chapter 46, as follows: CHAPTER 46. TERTIARY MEDICAL CARE Sec. 46.001. DEFINITIONS. Defines "tertiary care facility," "tertiary medical services," and "unreimbursed tertiary medical service." Sec. 46.002. RULES. Authorizes the Texas Board of Health (board) to adopt rules to implement this chapter. Sec. 46.003. TERTIARY CARE FACILITY ACCOUNT. Provides that the tertiary care facility account is an account in the state treasury. Authorizes the appropriation of money in the account only to TDH for the purposes of this chapter. Authorizes TDH to seek and accept gifts, grants, and donations from any public or private entity on behalf of the account. Provides that Section 403.095 (Use of Dedicated Revenue), Government Code, does not apply to the account. Requires that five percent of the total amount in the account, for each fiscal year, be held in reserve and authorizes its use only to pay for unreimbursed tertiary medical services provided as a result of extraordinary emergencies occurring during that year in accordance with this chapter. Prohibits more than five percent of the amount remaining from being used for the costs of administering the account. Sec. 46.004. COLLECTION OF INFORMATION. Requires a tertiary care facility that seeks payment under this chapter to submit to TDH, in the manner and the time required by TDH, information that related to the unreimbursed tertiary medical services provided to persons who reside outside the service area of the county, public hospital, or hospital district that is responsible for indigent health care under Chapter 61 in the area in which the tertiary care facility is located. Requires the board to adopt rules governing the collection of such information. Sec. 46.005. CERTIFICATION TO COMPTROLLER. (a) Requires TDH to certify to the comptroller for each tertiary care facility the cost of unreimbursed tertiary medical services provided by the facility to persons who reside outside the service area of the county, public, hospital, or hospital district that is responsible for indigent health care under Chapter 61 in the area in which the tertiary care facility is located. (b) Requires TDH, each year, for a facility that was a designated tertiary care facility during the previous year, an initial certification to the comptroller under Subsection (a) in an amount that equals 80 percent of the amount certified under this section for the facility in the previous year. Requires TDH to make a subsequent certification of the cost of additional unreimbursed tertiary medical services provided by the facility on receipt from the facility of the information required to be submitted under Section 46.004. (c) Requires TDH, if in any year the total cost of unreimbursed tertiary medical services certified under Subsection (a) for all tertiary care facilities exceeds the amount available for payment to the facilities under Section 46.003(e), to allocate the amount available under Section 46.003(e) to each facility based on the percentages computed by dividing the cost of the facility's unreimbursed tertiary medical services by the total cost of all facilities' unreimbursed tertiary medical services. (d) Provides that the cost of each unreimbursed tertiary medical service provided, for the purposes of Section 46.006, is the average amount payable under Medicare for services for the Medicare diagnosis related groups applicable to the tertiary medical services provided by a tertiary care facility. Sec. 46.006. CERTIFICATION OF EMERGENCIES. Requires TDH, for the purposes of reimbursing extraordinary emergencies under this chapter, to certify an extraordinary emergency if an emergency is declared by the governor or the president of the U.S., or for another similar disaster TDH finds has resulted in an extraordinary cost to a tertiary care facility. Requires TDH, if an extraordinary emergency is declared, to certify to the comptroller the amount of unreimbursed tertiary medical services incurred by a tertiary care facility during the emergency. Requires the comptroller to pay the tertiary care facility. ARTICLE 3. FEDERAL AUTHORIZATION FOR STATE MEDICAID PROGRAM SECTION 3.01. FEDERAL AUTHORIZATION. Sets forth legislative intent. ARTICLE 4. STUDY RELATING TO BASIC HEALTH CARE SERVICES AND STATE ASSISTANCE SECTION 4.01. STUDY. Requires TDH to study the provision of basic health care services by counties, hospital districts, and public hospitals under Chapter 61, Health and Safety Code, and the cost of providing those services. 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 4.02. 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 4.03. EXPIRATION. Provides that this article expires August 31, 2001. ARTICLE 5. PILOT PROGRAM FOR REGIONAL HEALTH CARE DELIVERY SYSTEM SECTION 5.01. DEFINITIONS. Defines "commissioner" and "pilot program." SECTION 5.02. 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) to coordinate the use of health care resources in a region of the state. Provides that the pilot program must address certain issues. Authorizes the commissioner to adopt rules as necessary to implement the pilot program. Authorizes that the rules provide an alternative funding structure to the funding structure established under Chapter 61, Health and Safety Code. Prohibits the commissioner from requiring a county, public hospital, hospital district, or other entity to participate in the pilot program SECTION 5.03. REPORT. Requires the commissioner, not later than January 1, 2003, 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 5.04. EXPIRATION; TERMINATION OF PILOT PROGRAM. Provides that this section expires and the pilot program is terminated August 31, 2003. ARTICLE 6. EFFECTIVE DATE; EMERGENCY SECTION 6.01. Effective date: September 1, 1999. SECTION 6.02. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute differs from the original in ARTICLE 1, as follows: Modifies SECTION 1.02 by amending Section 61.004, Health and Safety Code, relating to residence or eligibility dispute, rather than amending Subchapter A, Chapter 61, Health and Safety Code, by adding Section 61.0055 (Administration and Enforcement; Rules). Creates a new SECTION 1.03 that amends Subchapter A, Chapter 61, Health and Safety Code, by adding Section 61.0045 (Information Necessary to Determine Eligibility). For a complete analysis of this new section, please see the Section-by-Section Analysis portion of this document. Redesignates SECTION 1.03 of the original, which amends Sections 61.006 and 61.007, Health and Safety Code, as SECTION 1.04. Modifies the proposed amendment of Section 61.006 by providing that the minimum health care assistance eligibility standards must incorporate a net income eligibility level equal to 25 percent of the federal poverty level based on the federal Office of Management and Budget poverty index, rather than prohibiting the eligibility standards from being more restrictive than the eligibility standards used by the Texas Department of Human Services to determine eligibility in the Temporary Assistance for Needy Families (TANF)-Medicaid program. Modifies Section 61.006 by adding new Subsection (b-1) to provide that the minimum eligibility standards, effective January 1, 2000, must incorporate a net income eligibility level equal to 22 percent of the federal poverty level based on the OMB poverty index, and that Subsection (b-1) expires December 31, 2000. Further modifies Section 61.006 by requiring, rather than authorizing, TDH to establish application, documentation, and verification procedures that are consistent with the analogous, rather than different from and less restrictive than the, procedures used to determine eligibility in the TANF-Medicaid program. Further modifies Section 61.006 by deleting proposed new Subsection (f) relating to the entitled eligibility of certain persons, and by making conforming changes. Redesignates SECTION 1.04 of the original as SECTION 1.05 of the substitute. Creates a new SECTION 1.06 that amends Subchapter B, Chapter 61, Health and Safety Code, by adding Section 61.0235 (County Jail Inmates). For a complete analysis of this new section, please see the Section-by-Section Analysis portion of this document. Redesignates SECTION 1.05 of the original, which amends Section 61.025(d), Health and Safety Code, as SECTION 1.07 and modifies it by making a conforming change. Redesignates SECTION 1.06 of the original, which amends Section 61.028, Health and Safety Code, as SECTION 1.08. Modifies the proposed amendment of Section 61.028 by requiring the county to provide certain basic, rather than mandatory, health care services. Modifies it by reflecting change in the title of the section. Modifies it by making conforming changes. Redesignates SECTION 1.07 of the original, which amends Subchapter B, Chapter 61, Health and Safety Code, by adding Section 61.0285 (Optional Health Care Services) and 61.0286 (Premium Payments for Health Benefit Plan), as SECTION 1.09. Modifies SECTION 1.09 by deleting the addition of Section 61.0286. Modifies proposed Section 61.0285 by changing proposed language in Subsections (a) and (b) and adding Subsection (c) regarding optional health care services. Creates a new SECTION 1.10 to amend Section 61.031(b), Health and Safety Code, to require that notice of health care services provided, made by a provider of assistance to a patient's county of residence, be made by telephone not later than the 72nd hour, rather than as soon as possible, after the provider determines the patient's county of residence, and by mail postmarked not later than the fifth, rather than third, working day after the date on which the provider determines the patient's county of residence. Creates a new SECTION 1.11 to amend Section 61.032(a), Health and Safety Code, to make a conforming change. Redesignates SECTION 1.08 of the original, which amends Section 61.034, Health and Safety Code, as SECTION 1.12, and modifies it by making conforming changes to the title and the text. Redesignates SECTION 1.09 of the original, which amends Section 61.036(b), Health and Safety Code, as SECTION 1.13. Redesignates SECTION 1.10 of the original, which amends Sections 61.037, 61.038, and 61.039, Health and Safety Code, as SECTION 1.14. Modifies the proposed amendment of Section 61.037 by adding new Subsections (g) and (h) regarding the authority of TDH to waive the requirement of a county to meet the minimum health care assistance expenditure level, and by making conforming changes. Modifies the proposed amendment to Section 61.038 by making conforming changes. Deletes SECTION 1.11 of the original, the addition of Section 61.0395 (Additional State Assistance for Out-of-County Tertiary Care), Health and Safety Code. Redesignates SECTION 1.12 of the original, which amends Section 61.041, Health and Safety Code, as SECTION 1.15. Modifies the proposed amendment of Section 61.041 by deleting proposed language regarding the reporting requirements of all counties, by adding a new Subsection (d) regarding annual reporting requirements, and by making conforming changes. Deletes SECTION 1.13 of the original, the addition of Section 61.0415 (Performance Standards for Primary and Preventative Care), Health and Safety Code. Redesignates SECTION 1.14 of the original, which amends Section 61.054(a), Health and Safety Code, as SECTION 1.17, and modifies it by making conforming change. Redesignates SECTION 1.15 of the original, which amends Section 61.055, Health and Safety Code, as SECTION 1.18, and modifies it to make a conforming change. Deletes SECTION 1.16 of the original, which amends Section 157.006, Local Government Code. Creates a new SECTION 1.19 to amend Section 61.058(b), Health and Safety Code, to make a conforming change. Creates a new SECTION 1.20 to amend Section 61.059(a), Health and Safety Code, to make a conforming change. Creates a new SECTION 1.21 to amend Section 61.062, Health and Safety Code, to make conforming changes. Redesignates SECTION 1.17 of the original, which amends Section 531.204(b), Government Code, as SECTION 1.23. Creates new SECTION 1.24 to amends Chapter 26, Tax Code, by adding Section 26.0441 (Tax Adjustment for Indigent Health Care). For a complete analysis of this new section, please see the Section-by-Section Analysis portion of this document. Redesignates SECTION 1.18 of the original, which makes application of Article 1 prospective to January 1, 2000, as SECTION 1.25. Creates new SECTION 1.26, regarding a TDH study of uniform identification cards for health care assistance. Creates a new ARTICLE 2 (Tertiary Care), to amend Subtitle B, Title 2, Health and Safety Code, by adding Chapter 46 (Tertiary Medical Care). For a complete analysis of this new section, please see the Section-by-Section Analysis portion of this document. Redesignates ARTICLE 2 of the original (Federal Authorization for State Medicaid Program) as ARTICLE 3, and modifies it by adding Subdivision (3) regarding legislative intent. Redesignates ARTICLE 3 of the original (Threshold for State Assistance to Counties) as ARTICLE 4, and retitles it "Study Relating to Basic Health Care Services and State Assistance." Redesignates SECTION 3.01 of the original as SECTION 4.01, and modifies it by requiring TDH to study the provision of basic health care services by counties, hospital districts, and public hospitals under Chapter 61, Health and Safety Code, and the cost of providing those services; and by making conforming and nonsubstantive changes. Deletes SECTION 3.02 of the original (Work Group). Redesignates SECTION 3.03 of the original (Report) as SECTION 4.02, and modifies it by making a conforming change. Redesignates SECTION 3.04 or the original (Expiration) as SECTION 4.03. Redesignates ARTICLE 4 of the original (Pilot Program for Regional Health Care Delivery System) as ARTICLE 5. Redesignates SECTION 4.01 of the original (Definitions) as SECTION 5.01, and modifies it by deleting definitions of "fund," "hospital district," "public hospital," and "regional advisory committee." Redesignates SECTION 4.02 of the original (Pilot Program) as SECTION 5.02, and modifies it by requiring 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) to coordinate the use of health care resources in a region of the state, rather than requiring the commissioner to establish a regional health care delivery system pilot program in one region of the state. Further modifies SECTION 5.02 by providing that the pilot program must address certain issues; authorizing the commissioner to adopt rules as necessary to implement the pilot program; authorizing that the rules provide an alternative funding structure to the funding structure established under Chapter 61, Health and Safety Code; prohibiting the commissioner from requiring a county, public hospital, hospital district, or other entity to participate in the pilot program; and deleting proposed language regarding establishment of the pilot program. Deletes SECTIONS 4.03 (Regional Health Care Delivery System Trust Fund), 4.04 (Regional Health Care Delivery System), 4.05 (Rules), and 4.06 (Delegation of Power or Duties) of the original. Redesignates SECTION 4.07 (Report) as SECTION 5.03, and modifies it by making conforming changes. Redesignates SECTION 4.08 (Expiration; Termination of Pilot Program) as SECTION 5.04. Redesignates ARTICLE 5 of the original (Effective Date; Emergency) as ARTICLE 6.