81R24773 KFF-D
By: Shelton, Zerwas, Rose, Pitts, Naishtat, H.B. No. 2686
et al.
Substitute the following for H.B. No. 2686:
By: Zerwas C.S.H.B. No. 2686
A BILL TO BE ENTITLED
AN ACT
relating to a pilot project to increase enrollee access to primary
care services and simplify enrollment procedures under the child
health plan program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 62, Health and Safety
Code, is amended by adding Section 62.160 to read as follows:
Sec. 62.160. PILOT PROJECT TO INCREASE ENROLLEE ACCESS TO
PRIMARY CARE SERVICES AND SIMPLIFY ENROLLMENT PROCEDURES. (a) In
this section:
(1) "CPT code" means the number assigned to identify a
specific health care procedure performed by a health care provider
under the American Medical Association's "Current Procedural
Terminology 2009 Professional Edition" or a subsequent edition of
that publication adopted by the executive commissioner by rule.
(2) "Lower-cost medical setting" means a facility,
clinic, center, office, or other setting primarily used to provide
primary care services.
(3) "Primary care services" means health services
generally provided through a general, family, internal medicine, or
pediatrics practice. The term does not include services provided
through a hospital emergency room or surgical services.
(4) "Service area" means the geographical area
determined by the commission that is coterminous with one or more
Medicaid service areas and in which the pilot project is
established.
(b) The commission shall establish a two-year pilot project
in one or more Medicaid service areas that is designed to:
(1) increase child health plan enrollee access to
primary care services; and
(2) simplify child health plan enrollment procedures.
(c) In establishing the pilot project under this section,
the executive commissioner shall:
(1) for each service area, establish health care
provider reimbursement rates for primary care services provided in
lower-cost medical settings that are comparable to the federal
Medicare program rates for the same or similar services;
(2) identify CPT codes that represent primary care
services for purposes of Subdivision (1);
(3) prescribe and use an alternative application for
child health plan coverage that is written on a sixth-grade reading
comprehension level; and
(4) require any enrollment services provider in a
service area to reduce application processing delays and procedural
denials and increase renewal rates.
(d) An individual who resides in the service area and who is
determined eligible for coverage under the child health plan
remains eligible for benefits until the expiration of the period
provided by Section 62.102(a), subject to Section 62.102(b).
(e) The commission shall provide at least one point of
service contact in each county in the service area where trained
personnel are available to personally assist interested
individuals who reside in the service area with the application
form and procedures for child health plan coverage.
(f) The commission may only enroll an individual in the
child health plan program under the pilot project established under
this section during the first year of the project.
(g) Not later than January 1, 2011, the commission shall
submit an initial report to the governor, the lieutenant governor,
the speaker of the house of representatives, and the presiding
officers of the standing committees of the senate and house of
representatives having primary jurisdiction over the child health
plan program. The report must evaluate the operation of the pilot
project and make recommendations regarding the continuation or
expansion of the pilot project. The report must:
(1) state whether:
(A) a higher percentage of eligible individuals
in the service area enrolled in the child health plan as a result of
the pilot project, as compared to percentages in other areas;
(B) a higher percentage of health plan providers
in the service area participated in the child health plan as a
result of the pilot project, as compared to percentages in other
areas; and
(C) the enrollment changes implemented under the
pilot project:
(i) reduced application processing delays
and procedural denials; and
(ii) affected reenrollment rates; and
(2) include recommendations for the statewide
implementation of successful pilot project strategies.
(h) The commission shall submit a final report regarding the
results of the pilot project in the manner prescribed by Subsection
(g) not later than the 60th day after the date the pilot project
terminates. The report must contain the information required by
Subsection (g).
(i) The executive commissioner shall adopt rules necessary
to implement this section.
(j) This section expires January 1, 2013.
SECTION 2. Subject to Section 3 of this Act, not later than
October 1, 2009, the Health and Human Services Commission shall
establish the pilot project required under Section 62.160, Health
and Safety Code, as added by this Act.
SECTION 3. 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 4. This Act takes effect immediately if it 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 immediate effect, this
Act takes effect September 1, 2009.