Texas 2009 - 81st Regular

Texas Senate Bill SB2383 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R2256 ALB-D
2	2	By: Shapleigh S.B. No. 2383
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to universal health coverage for Texans.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	ARTICLE 1. HEALTH COVERAGE PROGRAM
10	10	SECTION 1.01. The Health and Safety Code is amended by
11	11	adding Title 13 to read as follows:
12	12	TITLE 13. UNIVERSAL HEALTH COVERAGE FOR TEXANS
13	13	SUBTITLE A. GOVERNANCE OF HEALTH COVERAGE PROGRAM
14	14	CHAPTER 2001. GENERAL PROVISIONS
15	15	Sec. 2001.001. DEFINITIONS. In this title:
16	16	(1) "Agency" means the Texas Health Coverage Agency.
17	17	(2) "Commissioner" means the commissioner of health
18	18	coverage.
19	19	(3) "Finance director" means the finance director of
20	20	the system.
21	21	(4) "Health care facility" means a public or private
22	22	hospital, skilled nursing facility, intermediate care facility,
23	23	ambulatory surgical facility, family planning clinic that performs
24	24	ambulatory surgical procedures, rural or urban health initiative
25	25	clinic, kidney disease treatment facility, inpatient
26	26	rehabilitation facility, and any other facility designated a health
27	27	care facility by federal law. The term does not include the offices
28	28	of physicians or health care providers practicing individually or
29	29	in groups.
30	30	(5) "Health care provider" means an individual who is
31	31	licensed, certified, or otherwise authorized to provide or render
32	32	health care in the ordinary course of business or practice of a
33	33	profession.
34	34	(6) "Integrated health care system" has the meaning
35	35	assigned by Section 281.0517.
36	36	(7) "Premium commission" means the health care premium
37	37	commission.
38	38	(8) "System" means the Texas Health Coverage System.
39	39	CHAPTER 2002. GOVERNANCE OF TEXAS HEALTH COVERAGE AGENCY
40	40	SUBCHAPTER A. GENERAL PROVISIONS
41	41	Sec. 2002.001. DUTIES OF AGENCY. The Texas Health Coverage
42	42	Agency administers the Texas Health Coverage System under this
43	43	title.
44	44	Sec. 2002.002. SUNSET PROVISION. The agency is subject to
45	45	Chapter 325, Government Code (Texas Sunset Act). Unless continued
46	46	in existence as provided by that chapter, the agency is abolished
47	47	September 1, 2019.
48	48	Sec. 2002.003. GRANTS; FEDERAL FUNDING. The agency may
49	49	accept gifts, grants, and donations, including grants from the
50	50	federal government, to administer this title and provide health
51	51	coverage through the system.
52	52	[Sections 2002.004-2002.050 reserved for expansion]
53	53	SUBCHAPTER B. COMMISSIONER
54	54	Sec. 2002.051. COMMISSIONER. (a) The commissioner of
55	55	health coverage is appointed by the governor with the advice and
56	56	consent of the senate.
57	57	(b) The commissioner shall be appointed without regard to
58	58	race, color, disability, sex, religion, age, or national origin.
59	59	Sec. 2002.052. TERM. The commissioner serves a two-year
60	60	term expiring on February 1 of each odd-numbered year.
61	61	Sec. 2002.053. ELIGIBILITY FOR SERVICE. (a) In this
62	62	section, "Texas trade association" means a cooperative and
63	63	voluntarily joined statewide association of business or
64	64	professional competitors in this state designed to assist its
65	65	members and its industry or profession in dealing with mutual
66	66	business or professional problems and in promoting their common
67	67	interest.
68	68	(b) A person is not eligible to serve as commissioner if, at
69	69	any time within two years before the date on which service as
70	70	commissioner begins:
71	71	(1) the person is an officer, employee, or paid
72	72	consultant of a business or Texas trade association in the field of
73	73	health insurance, pharmaceuticals, or medical equipment; or
74	74	(2) the person's spouse is an officer, employee, or
75	75	paid consultant of a business or Texas trade association in the
76	76	field of health insurance, pharmaceuticals, or medical equipment.
77	77	(c) A person may not serve as commissioner if the person is
78	78	required to register as a lobbyist under Chapter 305, Government
79	79	Code, because of the person's activities for compensation on behalf
80	80	of a profession related to the operation of the agency.
81	81	(d) A person appointed to serve as commissioner may not
82	82	serve as an officer, employee, or paid consultant of a business or
83	83	Texas trade association in the field of health insurance,
84	84	pharmaceuticals, or medical equipment for a period of two years
85	85	after the person's appointment as commissioner ends.
86	86	Sec. 2002.054. POWERS AND DUTIES OF COMMISSIONER. (a) The
87	87	commissioner is the executive officer of the agency and is
88	88	responsible for administering the agency and the system.
89	89	(b) The commissioner may:
90	90	(1) set rates for payments by and to the system,
91	91	including premium payments owed to the system, and establish the
92	92	budget for the system;
93	93	(2) establish system objectives, priorities, and
94	94	standards;
95	95	(3) employ agency personnel;
96	96	(4) allocate system resources in accordance with this
97	97	title; and
98	98	(5) oversee the establishment and administration of
99	99	the following:
100	100	(A) the health coverage policy board;
101	101	(B) the health coverage advisory committee;
102	102	(C) the office of patient advocacy;
103	103	(D) the office of health care planning;
104	104	(E) the office of health care quality;
105	105	(F) the health coverage fund;
106	106	(G) the payments board; and
107	107	(H) partnerships for health.
108	108	(c) The commissioner may adopt rules to administer the
109	109	system and implement this title in accordance with Subchapter B,
110	110	Chapter 2001, Government Code.
111	111	(d) The commissioner shall oversee the establishment of
112	112	locally based integrated service networks, including physicians in
113	113	fee-for-service, solo, and group practice and essential community
114	114	and ancillary care providers and facilities, in order to pool and
115	115	assign resources, form interdisciplinary teams that share
116	116	responsibility and accountability for patient care, and provide a
117	117	continuum of coordinated high-quality primary to tertiary care to
118	118	residents of this state while preserving patient choice.
119	119	Sec. 2002.055. SYSTEM OFFICERS. The commissioner shall
120	120	appoint the following system officers:
121	121	(1) the deputy commissioner;
122	122	(2) the finance director;
123	123	(3) the patient advocate for the office of patient
124	124	advocacy;
125	125	(4) the inspector general;
126	126	(5) the director of the office of health care
127	127	planning;
128	128	(6) the chief medical officer;
129	129	(7) the payments board director;
130	130	(8) the director for the partnerships for health;
131	131	(9) a regional director for each health care planning
132	132	region;
133	133	(10) a chief enforcement counsel; and
134	134	(11) legal counsel, as determined by the commissioner.
135	135	[Sections 2002.056-2002.100 reserved for expansion]
136	136	SUBCHAPTER C. HEALTH COVERAGE POLICY BOARD AND HEALTH COVERAGE
137	137	ADVISORY COMMITTEE
138	138	Sec. 2002.101. HEALTH COVERAGE POLICY BOARD. (a) The
139	139	health coverage policy board establishes policy for the system and
140	140	advises the commissioner concerning the operation of the system.
141	141	The board assists the commissioner to establish:
142	142	(1) system objectives, priorities, and standards,
143	143	including research and capital investment priorities;
144	144	(2) the scope of services provided by the system;
145	145	(3) guidelines for evaluating the performance of the
146	146	system; and
147	147	(4) guidelines for ensuring public input.
148	148	(b) The health coverage policy board is composed of the
149	149	following 11 members:
150	150	(1) the commissioner;
151	151	(2) the deputy commissioner;
152	152	(3) the finance director;
153	153	(4) the patient advocate;
154	154	(5) the chief medical officer;
155	155	(6) the director of the office of health care
156	156	planning;
157	157	(7) the director of partnerships for health;
158	158	(8) the director of the payments board;
159	159	(9) one member of the health coverage advisory
160	160	committee, to be determined by the health coverage advisory
161	161	committee; and
162	162	(10) two representatives from regional planning
163	163	boards.
164	164	(b) The commissioner serves as the presiding officer of the
165	165	board.
166	166	(c) The members of the health coverage policy board
167	167	designated under Subsections (a)(9) and (10) serve two-year terms.
168	168	Sec. 2002.102. HEALTH COVERAGE ADVISORY COMMITTEE. (a)
169	169	The health coverage advisory committee advises the commissioner and
170	170	the health coverage policy board concerning implementation of the
171	171	system.
172	172	(b) The commissioner shall appoint the following members to
173	173	the health coverage advisory committee:
174	174	(1) four physicians, at least one of whom must be a
175	175	psychiatrist;
176	176	(2) one registered nurse;
177	177	(3) one licensed vocational nurse;
178	178	(4) one licensed allied health practitioner;
179	179	(5) one mental health care provider;
180	180	(6) one dentist;
181	181	(7) one representative of private hospitals;
182	182	(8) one representative of public hospitals;
183	183	(9) one representative of an integrated health care
184	184	delivery system;
185	185	(10) four consumers of health care, at least one of
186	186	whom is disabled and at least one of whom is at least 65 years of
187	187	age;
188	188	(11) one representative of organized labor;
189	189	(12) one representative of a health care facility that
190	190	serves low-income residents;
191	191	(13) one union member;
192	192	(14) one representative of an employer who employs
193	193	more than 50 employees;
194	194	(15) one representative of an employer who employs
195	195	fewer than 50 employees; and
196	196	(16) one pharmacist.
197	197	(c) In making appointments, the commissioner shall attempt
198	198	to reflect the geographic and cultural diversity of this state.
199	199	(d) Members of the health coverage advisory committee serve
200	200	two-year terms.
201	201	Sec. 2002.103. DISCRIMINATION PROHIBITED. The members of
202	202	the health coverage policy board and health coverage advisory
203	203	committee shall be appointed without regard to race, color,
204	204	disability, sex, religion, age, or national origin.
205	205	Sec. 2002.104. ELIGIBILITY. (a) It is a ground for removal
206	206	from the health coverage policy board or health coverage advisory
207	207	committee that a member:
208	208	(1) is ineligible for membership under this
209	209	subchapter;
210	210	(2) cannot, because of illness or disability,
211	211	discharge the member's duties for a substantial part of the member's
212	212	term; or
213	213	(3) is absent from more than half of the regularly
214	214	scheduled board or committee meetings that the member is eligible
215	215	to attend during a calendar year without an excuse approved by a
216	216	majority vote of the board or committee, as applicable.
217	217	(b) A person may not serve as a member of the health coverage
218	218	policy board or health coverage advisory committee if the person is
219	219	required to register as a lobbyist under Chapter 305, Government
220	220	Code, because of the person's activities for compensation on behalf
221	221	of a profession related to the operation of the agency.
222	222	(c) If the commissioner has knowledge that a potential
223	223	ground for removal exists, the commissioner shall notify the
224	224	presiding officer of the board or committee, as applicable, of the
225	225	potential ground. The presiding officer shall then notify the
226	226	governor and the attorney general that a potential ground for
227	227	removal exists. If the potential ground for removal involves the
228	228	presiding officer, the commissioner shall notify the next highest
229	229	ranking officer of the board or committee, as applicable, who shall
230	230	then notify the governor and the attorney general that a potential
231	231	ground for removal exists.
232	232	Sec. 2002.105. TRAINING. (a) A person who is appointed to
233	233	and qualifies for office as a member of the health coverage policy
234	234	board or health coverage advisory committee may not vote,
235	235	deliberate, or be counted as a member in attendance at a meeting of
236	236	the board or committee until the person completes a training
237	237	program that complies with this section.
238	238	(b) The training program must provide the person with
239	239	information regarding:
240	240	(1) this title;
241	241	(2) the programs, functions, rules, and budget of the
242	242	agency;
243	243	(3) the results of the most recent formal audit of the
244	244	agency;
245	245	(4) the requirements of laws relating to open
246	246	meetings, public information, administrative procedure, and
247	247	conflicts of interest; and
248	248	(5) any applicable ethics policies adopted by the
249	249	agency or the Texas Ethics Commission.
250	250	(c) A person appointed to the health coverage policy board
251	251	or health coverage advisory committee is entitled to reimbursement,
252	252	as provided by the General Appropriations Act, for the travel
253	253	expenses incurred in attending the training program regardless of
254	254	whether the attendance at the program occurs before or after the
255	255	person qualifies for office.
256	256	Sec. 2002.106. COMPENSATION; REIMBURSEMENT. A person
257	257	appointed to the health coverage policy board or health coverage
258	258	advisory committee is not entitled to compensation for service on
259	259	the board or committee but is entitled to reimbursement, as
260	260	provided by the General Appropriations Act, for the expenses
261	261	incurred in attending board or committee meetings or performing
262	262	other official functions of the board or committee.
263	263	Sec. 2002.107. APPLICABILITY OF OTHER LAW. Chapter 2110,
264	264	Government Code, does not apply to the health coverage advisory
265	265	committee.
266	266	[Sections 2002.108-2002.150 reserved for expansion]
267	267	SUBCHAPTER D. OFFICE OF PATIENT ADVOCACY
268	268	Sec. 2002.151. OFFICE ESTABLISHED. The office of patient
269	269	advocacy is within the agency and is operated under the direction of
270	270	the patient advocate.
271	271	Sec. 2002.152. DUTIES OF OFFICE. The office:
272	272	(1) represents the interests of the public and
273	273	consumers of health care;
274	274	(2) assists patients in obtaining health care services
275	275	and benefits through the system;
276	276	(3) acts as an advocate for patients receiving
277	277	services and benefits through the system; and
278	278	(4) responds to complaints made to the agency.
279	279	Sec. 2002.153. PATIENT ADVOCATE. (a) The commissioner
280	280	shall appoint a patient advocate to administer the office.
281	281	(b) The patient advocate shall:
282	282	(1) oversee the establishment and maintenance of a
283	283	grievance process;
284	284	(2) participate in the grievance process under
285	285	Subdivision (1) and an independent medical review system on behalf
286	286	of consumers;
287	287	(3) receive, evaluate, and respond to consumer
288	288	complaints;
289	289	(4) receive recommendations from the public regarding
290	290	methods to improve the system and hold public hearings at least
291	291	annually;
292	292	(5) develop educational and informational guidelines
293	293	for consumers describing consumer rights and responsibilities and
294	294	informing consumers about effective ways to exercise the right to
295	295	secure health care services and participate in the system;
296	296	(6) establish a toll-free telephone number to receive
297	297	complaints;
298	298	(7) report annually to the public, the commissioner,
299	299	and the legislature regarding consumer perspective on system
300	300	performance, including recommendations for needed improvements;
301	301	and
302	302	(8) establish an independent medical review system to
303	303	provide timely examination of disputed health care services and
304	304	coverage decisions to ensure the system provides efficient,
305	305	appropriate services and responds to enrollee disputes.
306	306	[Sections 2002.154-2002.200 reserved for expansion]
307	307	SUBCHAPTER E. INSPECTOR GENERAL FOR HEALTH COVERAGE
308	308	Sec. 2002.201. INSPECTOR GENERAL APPOINTED. The inspector
309	309	general for health coverage is appointed by the commissioner.
310	310	Sec. 2002.202. DUTIES OF INSPECTOR GENERAL. (a) The
311	311	inspector general for health coverage shall:
312	312	(1) investigate, audit, and review the financial and
313	313	business records of entities that provide services or products to
314	314	the system;
315	315	(2) investigate allegations of misconduct by an agency
316	316	employee or appointee or by a provider of health care services
317	317	reimbursed by the system and report any findings of misconduct to
318	318	the attorney general;
319	319	(3) investigate patterns of medical practice that may
320	320	indicate fraud or abuse of power related to inappropriate
321	321	utilization of medical products and services;
322	322	(4) arrange for the collection and analysis of data
323	323	needed to investigate inappropriate utilization of products and
324	324	services under the system;
325	325	(5) conduct additional reviews or investigations when
326	326	requested by the governor or a member of the legislature and report
327	327	findings of the review to the governor, lieutenant governor, and
328	328	legislature; and
329	329	(6) establish a telephone hotline for anonymous
330	330	reporting of allegations of failure to make health insurance
331	331	premium payments established by the commission.
332	332	(b) The inspector general may refer any matter to the
333	333	attorney general, an appropriate prosecuting attorney, or a
334	334	regulatory agency of this state for criminal prosecution or
335	335	disciplinary action in accordance with law.
336	336	[Sections 2002.203-2002.250 reserved for expansion]
337	337	SUBCHAPTER F. OFFICE OF HEALTH CARE PLANNING
338	338	Sec. 2002.251. OFFICE. The office of health care planning
339	339	is within the agency and operates under the direction of the
340	340	director of the office.
341	341	Sec. 2002.252. DUTIES OF OFFICE. (a) The office of health
342	342	care planning shall assist the commissioner in planning for the
343	343	short-term and long-term health care needs of eligible residents of
344	344	this state in accordance with this title and the policies
345	345	established by the commissioner.
346	346	(b) The office of health care planning shall evaluate the
347	347	health care workforce and facility needs of this state, identify
348	348	medically underserved areas of this state, and develop plans to
349	349	provide services within those areas.
350	350	(c) The office of health care planning shall assist the
351	351	commissioner in developing performance criteria applicable to
352	352	health care goals.
353	353	Sec. 2002.253. DIRECTOR. The director of the office of
354	354	health care planning shall:
355	355	(1) establish performance criteria for health care
356	356	goals;
357	357	(2) evaluate the effectiveness of performance
358	358	criteria in measuring quality of care, administration, and
359	359	planning;
360	360	(3) assist the health care planning regions in
361	361	developing operating and capital requests;
362	362	(4) estimate the health care workforce needed to meet
363	363	the needs of the population and the cost to the state of that
364	364	workforce;
365	365	(5) estimate the number, types, and costs of
366	366	facilities required to meet the health care needs of this state; and
367	367	(6) appoint a technology advisory group to advise the
368	368	office regarding technological advances that streamline costs and
369	369	improve efficiency of the system.
370	370	[Sections 2002.254-2002.300 reserved for expansion]
371	371	SUBCHAPTER G. OFFICE OF HEALTH CARE QUALITY
372	372	Sec. 2002.301. ADMINISTRATION. The office of health care
373	373	quality is within the agency and operates under the direction of the
374	374	chief medical officer.
375	375	Sec. 2002.302. DUTIES OF OFFICE. The office of health care
376	376	quality shall assist the commissioner in supporting the delivery of
377	377	high-quality, efficient health care, monitoring the quality of care
378	378	delivered through the system, and promoting patient satisfaction
379	379	and shall assist the regional directors in the development and
380	380	evaluation of regional operating and capital budget requests.
381	381	Sec. 2002.303. CHIEF MEDICAL OFFICER. The chief medical
382	382	officer shall:
383	383	(1) collaborate with regional medical officers,
384	384	regional directors, and other necessary personnel to develop
385	385	community-based networks of providers to offer comprehensive,
386	386	multidisciplinary, coordinated services to patients;
387	387	(2) establish standards of care, based on best
388	388	practices, to serve as guidelines for providers;
389	389	(3) measure and monitor the quality of care throughout
390	390	the system;
391	391	(4) support health care providers in correcting
392	392	quality of care problems;
393	393	(5) identify medical errors and their causes and
394	394	develop plans to prevent errors; and
395	395	(6) provide information and assistance to the
396	396	commissioner regarding all aspects of quality of health care
397	397	delivered through the system.
398	398	[Sections 2002.304-2002.350 reserved for expansion]
399	399	SUBCHAPTER H. PARTNERSHIPS FOR HEALTH
400	400	Sec. 2002.351. PARTNERSHIPS FOR HEALTH. Partnerships for
401	401	health is a program within the agency that improves health through
402	402	community health initiatives, supports innovative methods to
403	403	improve health care quality, promotes efficient delivery of health
404	404	care, and educates the public.
405	405	Sec. 2002.352. DIRECTOR. The director of partnerships for
406	406	health is responsible for administration of the program.
407	407	Sec. 2002.353. ROLE OF PATIENT ADVOCATE. The patient
408	408	advocate shall work with community and health care providers to
409	409	propose partnerships for health projects.
410	410	[Sections 2002.354-2002.400 reserved for expansion]
411	411	SUBCHAPTER I. HEALTH CARE PLANNING REGIONS
412	412	Sec. 2002.401. HEALTH CARE PLANNING REGIONS ESTABLISHED.
413	413	(a) The commissioner, in consultation with the director of the
414	414	office of health care planning, shall establish geographically
415	415	contiguous health care planning regions for the state on the basis
416	416	of:
417	417	(1) patterns of usage of health care services;
418	418	(2) health care resources, including health care
419	419	workforce resources;
420	420	(3) health care needs, including public health needs;
421	421	(4) geography;
422	422	(5) population and demographic characteristics; and
423	423	(6) other considerations as determined by the
424	424	commissioner.
425	425	(b) To the extent consistent with Subsection (a), the
426	426	commissioner may designate as health care planning regions the
427	427	public health regions established by the Department of State Health
428	428	Services under Chapter 121.
429	429	Sec. 2002.402. REGIONAL DIRECTOR. (a) The commissioner
430	430	shall appoint a regional director for each health care planning
431	431	region. The regional director directs the health care planning
432	432	region and establishes health policy for the region.
433	433	(b) A regional director serves at the pleasure of the
434	434	commissioner and may serve not more than eight two-year terms.
435	435	Sec. 2002.403. DUTIES OF REGIONAL DIRECTOR. The regional
436	436	director shall:
437	437	(1) direct the region;
438	438	(2) reside in the region in which the director serves;
439	439	(3) establish and administer a regional office of the
440	440	commission, including an office of patient advocacy, an office of
441	441	health care planning, an office of health care quality, and an
442	442	office of partnerships for health;
443	443	(4) appoint a regional planning board and serve as the
444	444	executive director of the board;
445	445	(5) identify and prioritize regional health care needs
446	446	and goals, in collaboration with the regional medical officer,
447	447	regional health care providers, regional planning board, and
448	448	regional director of partnerships for health;
449	449	(6) assess projected revenue and expenditures to
450	450	ensure fiscal solvency of the regional planning system and advise
451	451	the commissioner regarding potential revenue shortfalls and the
452	452	possible need for cost containment measures;
453	453	(7) assure that regional administrative costs meet
454	454	standards established by the agency and seek innovative ways to
455	455	lower administrative costs;
456	456	(8) plan for the delivery of, and equal access to,
457	457	high-quality and culturally and linguistically sensitive health
458	458	care, including care to disabled persons;
459	459	(9) seek innovative and systemic methods to improve
460	460	health care quality and efficiency and to achieve system access for
461	461	all state residents;
462	462	(10) make needed revenue sharing arrangements so that
463	463	regionalization does not limit a patient's choice of provider;
464	464	(11) implement dispute resolution procedures;
465	465	(12) implement methods for public comment;
466	466	(13) report at regular intervals to the public and the
467	467	commissioner regarding the status of the regional planning system,
468	468	including evaluating access to care, quality of care, provider
469	469	performance, and other issues related to regional health care
470	470	needs;
471	471	(14) establish guidelines for providers to identify,
472	472	maintain, and provide to the regional director inventories of
473	473	regional health care assets;
474	474	(15) establish and maintain regional health care
475	475	databases that are coordinated with other regional and statewide
476	476	databases;
477	477	(16) in collaboration with the regional medical
478	478	officer, enforce reporting requirements established by the system;
479	479	(17) establish and implement a regional capital
480	480	management plan under the capital management plan established by
481	481	the commissioner for the system;
482	482	(18) implement standards and formats established by
483	483	the commissioner for the development and submission of operating
484	484	and capital budget requests and make recommendations to the
485	485	commissioner and the director of the office of health planning for
486	486	needed changes;
487	487	(19) support regional providers in developing
488	488	operating and capital budget requests;
489	489	(20) receive, evaluate, and prioritize provider
490	490	operating and capital budget requests under standards and criteria
491	491	established by the commissioner;
492	492	(21) prepare a three-year regional operating and
493	493	capital budget request that meets the health care needs of the
494	494	region under this division for submission to the commissioner; and
495	495	(22) establish a comprehensive three-year regional
496	496	planning budget using funds allocated to the region by the
497	497	commissioner.
498	498	Sec. 2002.404. REGIONAL MEDICAL OFFICER. (a) Each
499	499	regional director shall appoint a regional medical officer for each
500	500	health care planning region.
501	501	(b) A regional medical officer shall:
502	502	(1) administer all aspects of the regional office of
503	503	health care quality;
504	504	(2) serve as a member of the regional planning board;
505	505	(3) oversee the establishment of integrated service
506	506	networks that:
507	507	(A) include physicians in fee-for-service, solo,
508	508	and group practice, essential community and ancillary care
509	509	providers, and facilities;
510	510	(B) pool and align resources and form
511	511	interdisciplinary teams to share responsibility and accountability
512	512	for patient care; and
513	513	(C) provide a continuum of coordinated
514	514	high-quality primary to tertiary care to all residents of the
515	515	region;
516	516	(4) assure the evaluation and measurement of the
517	517	quality of health care delivered in the region, including
518	518	assessment of the performance of individual providers under
519	519	standards established by the chief medical officer, to ensure a
520	520	single standard of high-quality care is delivered to all state
521	521	residents;
522	522	(5) in collaboration with the chief medical officer
523	523	and regional providers, evaluate standards of care in use at the
524	524	time the system becomes operative;
525	525	(6) ensure a smooth transition toward use of standards
526	526	based on clinical efficacy that guide clinical decision-making;
527	527	(7) support the development and distribution of
528	528	user-friendly software for use by providers in order to support the
529	529	delivery of high-quality health care;
530	530	(8) provide feedback to, and support and supervision
531	531	of, health care providers to ensure the delivery of high-quality
532	532	care under standards established by the system;
533	533	(9) collaborate with the regional partnerships for
534	534	health to develop patient education to assist consumers in
535	535	evaluating and appropriately utilizing health care providers and
536	536	facilities;
537	537	(10) collaborate with regional public health officers
538	538	to establish regional health policies that support the public
539	539	health;
540	540	(11) establish a regional program to monitor and
541	541	decrease medical errors and their causes using standards and
542	542	methods established by the chief medical officer;
543	543	(12) support the development and implementation of
544	544	innovative means to provide high-quality care and assist providers
545	545	in securing funds for innovative demonstration projects that seek
546	546	to improve care quality;
547	547	(13) establish means to assess the impact of the
548	548	system's policies intended to assure the delivery of high-quality
549	549	care;
550	550	(14) collaborate with the chief medical officer, the
551	551	director of the office of health care planning, the regional
552	552	director, and health care providers in the development and
553	553	maintenance of regional health care databases;
554	554	(15) ensure the enforcement of, and recommend needed
555	555	changes to, the system's reporting requirements;
556	556	(16) support providers in developing regional budget
557	557	requests; and
558	558	(17) annually report to the commissioner, the public,
559	559	the regional planning board, and the chief medical officer on the
560	560	status of regional health care programs, needed improvements, and
561	561	plans to implement and evaluate delivery of care improvements.
562	562	Sec. 2002.405. REGIONAL PLANNING BOARD. The commissioner
563	563	shall appoint a regional planning board for each health care
564	564	planning region. The regional planning board shall advise the
565	565	regional director concerning health policy for the region.
566	566	Sec. 2002.406. COMPOSITION OF REGIONAL PLANNING BOARD. (a)
567	567	A regional director shall appoint 13 members to a regional planning
568	568	board.
569	569	(b) Members serve two-year terms that coincide with the term
570	570	of the regional director and may be reappointed for not more than
571	571	eight terms.
572	572	(c) Regional planning board members must have resided for at
573	573	least two years in the region in which they serve before appointment
574	574	to the board.
575	575	(d) Regional planning board members shall reside in the
576	576	region they serve while on the board.
577	577	(e) The board consists of the following members:
578	578	(1) the regional director;
579	579	(2) the regional medical officer;
580	580	(3) the regional director of partnerships for health;
581	581	(4) a public health officer from one of the counties in
582	582	the region, rotating among the county public health officers on a
583	583	timetable to be established by each regional planning board;
584	584	(5) a representative from the office of patient
585	585	advocacy;
586	586	(6) one expert in health care financing;
587	587	(7) one expert in health care planning;
588	588	(8) two members who are direct care providers in the
589	589	region, one of whom is a registered nurse;
590	590	(9) one member who represents ancillary health care
591	591	workers in the region;
592	592	(10) one member who represents hospitals in the
593	593	region;
594	594	(11) one member who represents essential community
595	595	providers in the region; and
596	596	(12) one member representing the public.
597	597	(f) The regional director serves as chair of the board.
598	598	(g) The regional planning board shall advise and make
599	599	recommendations to the regional director on all aspects of regional
600	600	health policy.
601	601	[Sections 2002.407-2002.450 reserved for expansion]
602	602	SUBCHAPTER J. OFFICE OF TRANSITION ASSISTANCE
603	603	Sec. 2002.451. TRANSITION ASSISTANCE. The office of
604	604	transition assistance is within the agency and operates under the
605	605	direction of the commissioner.
606	606	Sec. 2002.452. TRANSITION ADVISORY COMMITTEE. The
607	607	commissioner shall appoint a transition advisory group composed of
608	608	the following members:
609	609	(1) the commissioner;
610	610	(2) the patient advocate;
611	611	(3) the chief medical officer;
612	612	(4) the director of the office of health care
613	613	planning;
614	614	(5) the finance director;
615	615	(6) experts in health care financing and health care
616	616	administration;
617	617	(7) direct care providers;
618	618	(8) representatives of retirement boards;
619	619	(9) employer and employee representatives;
620	620	(10) representatives of hospitals, integrated health
621	621	care delivery systems, and other health care facilities;
622	622	(11) representatives of state health and human
623	623	services agencies;
624	624	(12) representatives of counties; and
625	625	(13) health care consumers.
626	626	Sec. 2002.453. DUTIES OF OFFICE. The office of transition
627	627	assistance shall:
628	628	(1) provide assistance to individuals who lose
629	629	employment, directly or indirectly, as a result of the
630	630	implementation of the system, including job training and job
631	631	placement;
632	632	(2) advise the commission regarding the
633	633	implementation of the system;
634	634	(3) make recommendations to the commissioner
635	635	regarding the integration of health care delivery; and
636	636	(4) make recommendations to the governor, lieutenant
637	637	governor, and legislature regarding research needed to support
638	638	transition to the system.
639	639	Sec. 2002.454. EXPIRATION. This subchapter expires
640	640	December 31, 2014.
641	641	CHAPTER 2003. FISCAL MANAGEMENT
642	642	SUBCHAPTER A. HEALTH COVERAGE FUND
643	643	Sec. 2003.001. FUND. The health coverage fund is a fund in
644	644	the state treasury. The fund is composed of:
645	645	(1) all funds collected from health care;
646	646	(2) federal funds allocated to the fund; and
647	647	(3) other money allocated to the fund under law.
648	648	Sec. 2003.002. ADMINISTRATION OF FUND. (a) The finance
649	649	director administers the fund under the supervision and direction
650	650	of the commissioner.
651	651	(b) The finance director may employ actuaries, accountants,
652	652	and other experts as necessary to perform the finance director's
653	653	duties under law.
654	654	Sec. 2003.003. ACCOUNTS IN FUND. The finance director
655	655	shall establish the following accounts in the fund:
656	656	(1) a system account to provide for all annual state
657	657	expenditures for health care; and
658	658	(2) a reserve account.
659	659	Sec. 2003.004. PREMIUMS SUFFICIENT TO COVER COSTS.
660	660	Premiums collected each year under this title shall be sufficient
661	661	to cover that year's projected costs.
662	662	Sec. 2003.005. USE OF FUND. (a) Money in the fund may be
663	663	used in accordance with the General Appropriations Act to pay
664	664	claims for health care services provided through the system and the
665	665	administrative costs of the system.
666	666	(b) Not more than five percent of the money in the fund may
667	667	be used for administrative costs of the system.
668	668	(c) Notwithstanding Subsection (b), not more than 10
669	669	percent of the money in the fund may be used for administrative
670	670	costs of the system. This subsection expires August 31, 2022.
671	671	Sec. 2003.006. LEGISLATIVE APPROPRIATION REQUEST. (a) Not
672	672	later than November 1 of each even-numbered year, the commissioner,
673	673	in consultation with the finance director, shall submit to the
674	674	Legislative Budget Board:
675	675	(1) an estimate of projected system revenues under
676	676	this title;
677	677	(2) an estimate of projected system liabilities for
678	678	the succeeding fiscal biennium; and
679	679	(3) a legislative appropriation request for the
680	680	succeeding fiscal biennium.
681	681	(b) The legislative appropriation request shall specify
682	682	amounts to be allocated to the health care planning regions for
683	683	health care services in those regions.
684	684	(c) The legislative appropriation request must include
685	685	amounts necessary to provide transition assistance to individuals
686	686	who lose employment, directly or indirectly, as a result of the
687	687	implementation of the system. This subsection expires December 31,
688	688	2014.
689	689	Sec. 2003.007. RESERVES FOR FUTURE SYSTEM LIABILITY. (a)
690	690	The comptroller, at the direction of the finance director, shall
691	691	establish one or more separate accounts for system reserves against
692	692	future liability.
693	693	(b) The commissioner shall work with the Department of
694	694	Insurance, the Health and Human Services Commission, and other
695	695	experts to determine an appropriate level of reserves for the
696	696	system for the first year and future years of the system's
697	697	operation.
698	698	(c) Funds held in reserve by state health programs and
699	699	federal money for health care shall be transferred to the reserve
700	700	account at the time the state assumes financial responsibility for
701	701	health care.
702	702	Sec. 2003.008. SELF-INSURED SYSTEM. The commissioner may
703	703	implement a program to self-insure the system against unforeseen
704	704	expenditures or revenue shortfalls not covered by reserves or may
705	705	borrow funds to cover temporary revenue shortfalls not covered by
706	706	system reserves, including the issuance of revenue bonds payable
707	707	from the premiums received by the system for this purpose,
708	708	whichever is more cost effective.
709	709	Sec. 2003.009. DUTY TO MONITOR SYSTEM SOLVENCY; NOTICE TO
710	710	LEGISLATURE. The finance director shall monitor the solvency of
711	711	the system. If the finance director determines that system
712	712	liabilities may exceed system revenue in any year, the finance
713	713	director shall notify the commissioner, the health coverage policy
714	714	board, the governor, the lieutenant governor, and the speaker of
715	715	the house of representatives.
716	716	Sec. 2003.010. COST CONTAINMENT. (a) After receiving
717	717	notice under Section 2003.009, the commissioner, in consultation
718	718	with the finance director and the health coverage policy board, may
719	719	implement cost containment measures and may require each regional
720	720	planning board to impose cost containment measures within the
721	721	region subject to the board's jurisdiction.
722	722	(b) Cost containment measures may include:
723	723	(1) changes in the system or health facility
724	724	administration that improve efficiency;
725	725	(2) changes in the delivery of health care services
726	726	that improve efficiency and quality of care;
727	727	(3) postponement of introduction of new benefits or
728	728	benefit improvements;
729	729	(4) the seeking of statutory authority for a temporary
730	730	decrease in benefits;
731	731	(5) postponement of planned capital expenditures;
732	732	(6) adjustments of health care provider payments to
733	733	correct for deficiencies in quality of care and failure to meet
734	734	compensation contract performance goals;
735	735	(7) adjustments to compensation of managerial
736	736	employees and upper-level managers under contract with the system
737	737	to correct for deficiencies in management and failure to meet
738	738	contract performance goals;
739	739	(8) limitations on reimbursement budgets of the
740	740	system's providers and upper-level managers whose compensation is
741	741	determined by the payments board;
742	742	(9) limitations on aggregate reimbursements to
743	743	manufacturers of pharmaceutical and durable and nondurable medical
744	744	equipment;
745	745	(10) deferred funding of the reserve account;
746	746	(11) imposition of copayments or deductible payments
747	747	except where prohibited by federal law and as determined by federal
748	748	law for persons with low income; and
749	749	(12) imposition of an eligibility waiting period and
750	750	other means if the commissioner determines that many individuals
751	751	are emigrating to the state for the purpose of obtaining health care
752	752	through the system.
753	753	(c) Nothing in this section shall be construed to diminish
754	754	the benefits that an individual has under a collective bargaining
755	755	agreement.
756	756	(d) Nothing in this section shall preclude an employee from
757	757	receiving benefits available to the employee under a collective
758	758	bargaining agreement or other employee-employer agreement or a
759	759	statute that are superior to benefits under this section.
760	760	(e) Cost containment measures implemented under this
761	761	section must remain in place until the commissioner and the health
762	762	coverage policy board determine that the cause of a revenue
763	763	shortfall has been corrected.
764	764	(f) If the health coverage policy board determines that cost
765	765	containment measures implemented under this section are not
766	766	sufficient to meet a revenue shortfall, the commissioner shall
767	767	report to the legislature and the public on the causes of the
768	768	shortfall and the reasons for the failure of cost containment
769	769	measures and shall recommend measures to correct the shortfall,
770	770	including an increase in premium payments to the system.
771	771	Sec. 2003.011. REGIONAL COST CONTAINMENT. (a) If the
772	772	commissioner or a regional director determines that regional
773	773	revenue and expenditure trends indicate a need for regional cost
774	774	containment measures, the regional director shall convene the
775	775	regional planning board to discuss the possible need for cost
776	776	containment measures and make a recommendation about appropriate
777	777	measures to control costs.
778	778	(b) Cost containment measures under this section may
779	779	include any of the following:
780	780	(1) changes in the administration of the system or in
781	781	health facility administration that improve efficiency;
782	782	(2) changes in the delivery of health care services
783	783	and health system management that improve efficiency or quality of
784	784	care;
785	785	(3) postponement of planned regional capital
786	786	expenditures;
787	787	(4) adjustment of payments to health care providers to
788	788	reflect deficiencies in quality of care and failure to meet
789	789	compensation contract performance goals and payments to
790	790	upper-level managers to reflect deficiencies in management and
791	791	failure to meet compensation contract performance goals;
792	792	(5) adjustment of payments to health care providers
793	793	and upper-level managers above a specified amount of aggregate
794	794	billing; and
795	795	(6) adjustment of payments to pharmaceutical and
796	796	medical equipment manufacturers and others selling goods and
797	797	services to the system above a specified amount of aggregate
798	798	billing.
799	799	(c) Cost containment measures shall remain in place in a
800	800	region until the regional director and the commissioner determine
801	801	that the cause of a revenue shortfall has been corrected.
802	802	[Sections 2003.012-2003.050 reserved for expansion]
803	803	SUBCHAPTER B. FEDERAL FUNDING
804	804	Sec. 2003.051. APPLICATION FOR FEDERAL FUNDING. The
805	805	commissioner, through applications for appropriate waivers from
806	806	the Centers for Medicare and Medicaid Services or another
807	807	appropriate funding source, shall seek federal funding for the
808	808	operation of the system.
809	809	[Sections 2003.052-2003.100 reserved for expansion]
810	810	SUBCHAPTER C. BUDGET
811	811	Sec. 2003.101. SYSTEM BUDGET. The budget for the system
812	812	shall include each of the following:
813	813	(1) a transition budget;
814	814	(2) a providers and managers budget;
815	815	(3) a capitated operating budget;
816	816	(4) a noncapitated operating budget;
817	817	(5) a capital investment budget;
818	818	(6) a purchasing budget, including prescription drugs
819	819	and durable and nondurable medical equipment;
820	820	(7) a research and innovation budget;
821	821	(8) a workforce training and development budget;
822	822	(9) a system administration budget; and
823	823	(10) regional budgets.
824	824	Sec. 2003.102. BUDGET CONSIDERATIONS. In establishing a
825	825	budget under this section, the commissioner shall consider the
826	826	following:
827	827	(1) the costs of transition to the new system;
828	828	(2) projections regarding the health care services
829	829	anticipated to be used by residents of this state;
830	830	(3) differences in the costs of living between
831	831	regions, including the overhead costs of maintaining medical
832	832	practices;
833	833	(4) the health risk of enrollees;
834	834	(5) the scope of services provided;
835	835	(6) innovative programs that improve health care
836	836	quality, administrative efficiency, and workplace safety;
837	837	(7) the unrecovered costs of providing care to persons
838	838	who are not enrolled in the system;
839	839	(8) the costs of workforce training and development;
840	840	(9) the costs of corrective health outcome disparities
841	841	and the unmet needs of previously uninsured and underinsured
842	842	enrollees;
843	843	(10) relative usage of different health care
844	844	providers;
845	845	(11) needed improvements in access to care;
846	846	(12) projected savings in administrative costs;
847	847	(13) projected savings due to provision of primary and
848	848	preventive care to the population, including savings from decreases
849	849	in preventable emergency room visits and hospitalizations;
850	850	(14) projected savings from improvements in quality of
851	851	care;
852	852	(15) projected savings from decreases in medical
853	853	errors;
854	854	(16) projected savings from system-wide management of
855	855	capital expenditures;
856	856	(17) the cost of incentives and bonuses to support the
857	857	delivery of high-quality health care, including incentives and
858	858	bonuses needed to recruit and retain an adequate number of needed
859	859	providers and managers and to attract health care providers to
860	860	medically underserved areas;
861	861	(18) the costs of treating complex illnesses,
862	862	including disease management programs;
863	863	(19) the cost of implementing standards of health care
864	864	coordination;
865	865	(20) the cost of electronic medical records and other
866	866	electronic initiatives; and
867	867	(21) the costs of new technology, including research
868	868	and development costs.
869	869	[Sections 2003.103-2003.150 reserved for expansion]
870	870	SUBCHAPTER D. PAYMENTS BOARD
871	871	Sec. 2003.151. PAYMENTS BOARD. (a) The commissioner shall
872	872	establish the payments board and shall appoint a director and
873	873	members of the board.
874	874	(b) The payments board is composed of:
875	875	(1) experts in health care finance and insurance
876	876	systems;
877	877	(2) a designated representative of the commissioner;
878	878	(3) a designated representative of the health coverage
879	879	fund; and
880	880	(4) a representative of the regional directors.
881	881	(c) The position of regional representative shall rotate
882	882	among the directors of the regional planning boards every two
883	883	years.
884	884	Sec. 2003.152. COMPENSATION PLAN. (a) The payments board
885	885	shall establish and supervise a uniform payments system for health
886	886	care providers and managers and shall maintain a compensation plan
887	887	for each of the following health care providers and managers under
888	888	the providers and managers budget established by the commissioner:
889	889	(1) upper-level managers employed by, or under
890	890	contract with, private health care facilities;
891	891	(2) managers and officers of the system; and
892	892	(3) health care providers, including physicians,
893	893	osteopathic physicians, dentists, podiatrists, optometrists, nurse
894	894	practitioners, physician assistants, chiropractors,
895	895	acupuncturists, psychologists, social workers, marriage, family,
896	896	and child counselors, and other professional health care providers
897	897	who are licensed to practice in this state and who provide services
898	898	under the system.
899	899	(b) Health care providers licensed and accredited to
900	900	provide services in this state may choose to be compensated for
901	901	their services either by the system or by a person to whom they
902	902	provide services.
903	903	(c) Health care providers who elect to receive compensation
904	904	from the system shall enter into a contract with the system.
905	905	(d) Health care providers who elect to receive compensation
906	906	by individuals to whom they provide services instead of by the
907	907	system may establish charges for their services.
908	908	(e) A health care provider who accepts payment from the
909	909	system under this section may not bill a patient for any covered
910	910	service, except as authorized by the commissioner.
911	911	(f) A health care provider who receives compensation from
912	912	the system may choose to be compensated as a fee-for-service
913	913	provider or a provider employed by, or under contract with, a health
914	914	care system that provides comprehensive, coordinated services.
915	915	(g) Nothing in this section restricts the right of a
916	916	supervising health care provider to enter into a contractual
917	917	arrangement that provides for salaried compensation for employees
918	918	who must be supervised by a physician.
919	919	(h) The compensation plan must include the following:
920	920	(1) actuarially sound payments that include a just and
921	921	fair return for health care providers in the fee-for-service sector
922	922	and for health care providers working in health systems where
923	923	comprehensive and coordinated services are provided, including the
924	924	actuarial basis for the payment;
925	925	(2) payment schedules that are in effect for three
926	926	years; and
927	927	(3) bonus and incentive payments.
928	928	(i) A health care provider shall be paid for each service
929	929	provided, including care provided to an individual subsequently
930	930	determined to be ineligible for the system.
931	931	(j) A health care provider who delivers services that are
932	932	not covered under the system may establish rates and charge
933	933	patients for those services.
934	934	(k) Reimbursement to health care providers and compensation
935	935	to managers may not exceed the amount allocated by the commissioner
936	936	to provider and manager annual budgets.
937	937	Sec. 2003.153. REIMBURSEMENT FOR FEE-FOR-SERVICE
938	938	PROVIDERS. (a) Fee-for-service health care providers shall choose
939	939	representatives of their specialties to negotiate reimbursement
940	940	rates with the payments board on their behalf.
941	941	(b) The payments board shall establish a uniform system of
942	942	payments for all services provided.
943	943	(c) Payment schedules must be available to health care
944	944	providers in printed and electronic format.
945	945	(d) Payment schedules are in effect for three years. Payment
946	946	adjustments may be made at the discretion of the payments board to
947	947	meet the goals of the system.
948	948	(e) In establishing a uniform system of payments, the
949	949	payments board shall collaborate with regional directors and health
950	950	care providers and consider regional differences in the cost of
951	951	living and the need to recruit and retain skilled health care
952	952	providers in the region.
953	953	(f) Fee-for-service health care providers shall submit
954	954	claims electronically to the health coverage fund and shall be paid
955	955	not later than the 30th business day after the date the claim is
956	956	received.
957	957	[Sections 2003.154-2003.200 reserved for expansion]
958	958	SUBCHAPTER E. CAPITAL MANAGEMENT
959	959	Sec. 2003.201. CAPITAL MANAGEMENT PLAN. (a) The
960	960	commissioner shall develop a capital management plan that governs
961	961	all capital investments and acquisitions.
962	962	(b) The commissioner shall develop and maintain a capital
963	963	inventory for each region and establish a process for each region to
964	964	prepare a business plan that includes proposed investments and
965	965	acquisitions.
966	966	Sec. 2003.202. COMPETITIVE BIDDING PROCESS. (a) The
967	967	commissioner shall establish a competitive bidding process for the
968	968	development of capital management plans.
969	969	(b) The system may fund all or part of capital projects.
970	970	Sec. 2003.203. NO INVESTMENTS FROM OPERATING BUDGETS. A
971	971	capital investment may not be funded by money set aside in a
972	972	regional or system-wide operating budget.
973	973	Sec. 2003.204. REGIONAL CAPITAL INVESTMENT PLANS. Each
974	974	regional director shall submit to the commissioner a regional
975	975	capital management plan that is based on the capital management
976	976	plan developed by the commissioner under Section 2003.201.
977	977	[Sections 2003.205-2003.250 reserved for expansion]
978	978	SUBCHAPTER F. PREMIUM COMMISSION
979	979	Sec. 2003.251. HEALTH CARE PREMIUM COMMISSION. (a) The
980	980	health care premium commission is composed of 14 members, appointed
981	981	as follows:
982	982	(1) three health economists with experience relevant
983	983	to the duties of the commission, one of whom is appointed by the
984	984	governor, one of whom is appointed by the lieutenant governor, and
985	985	one of whom is appointed by the governor from a list submitted by
986	986	the speaker of the house of representatives;
987	987	(2) a representative of the business community, other
988	988	than the small business community, appointed by the governor;
989	989	(3) a representative of the small business community,
990	990	appointed by the lieutenant governor;
991	991	(4) two representatives of employees in this state,
992	992	one of whom is appointed by the lieutenant governor and one of whom
993	993	is appointed by the governor from a list submitted by the speaker of
994	994	the house of representatives;
995	995	(5) two representatives of nonprofit organizations
996	996	interested in the establishment of a system of universal health
997	997	care in this state, one of whom is appointed by the lieutenant
998	998	governor and one of whom is appointed by the governor from a list
999	999	submitted by the speaker of the house of representatives;
1000	1000	(6) one representative of a nonprofit advocacy
1001	1001	organization concerned with taxation policy and sustainable
1002	1002	funding for public infrastructure, appointed by the governor from a
1003	1003	list submitted by the speaker of the house of representatives;
1004	1004	(7) the comptroller, or the comptroller's designee;
1005	1005	(8) the director of the division of workforce
1006	1006	development of the Texas Workforce Commission;
1007	1007	(9) the executive commissioner of the Health and Human
1008	1008	Services Commission, or the executive commissioner's designee; and
1009	1009	(10) the lieutenant governor.
1010	1010	(b) The lieutenant governor and the speaker of the house of
1011	1011	representatives shall designate a member of the senate and the
1012	1012	house of representatives, respectively, to advise the premium
1013	1013	commission.
1014	1014	(c) The appointed members of the premium commission serve
1015	1015	for staggered terms of six years, with as near as possible to
1016	1016	one-third of the members' terms expiring every February 1 of each
1017	1017	odd-numbered year.
1018	1018	Sec. 2003.252. PREMIUM COMMISSION FUNCTIONS. The premium
1019	1019	commission shall perform the following functions:
1020	1020	(1) determine the aggregate costs of providing health
1021	1021	care coverage to residents of this state; and
1022	1022	(2) develop an equitable and affordable premium
1023	1023	structure that will generate adequate revenue for the health
1024	1024	coverage fund established under Subchapter A and ensure stable and
1025	1025	actuarially sound funding for the system.
1026	1026	Sec. 2003.253. PREMIUM STRUCTURE. (a) The premium
1027	1027	structure developed by the premium commission shall satisfy the
1028	1028	following criteria:
1029	1029	(1) be means-based and generate adequate revenue to
1030	1030	implement the system;
1031	1031	(2) to the greatest extent possible, ensure that all
1032	1032	income earners and all employers contribute a premium amount that
1033	1033	is affordable and consistent with existing funding sources for
1034	1034	health care in this state;
1035	1035	(3) maintain the current ratio for aggregate health
1036	1036	care contributions among the traditional health care funding
1037	1037	sources, including employers, individuals, government, and other
1038	1038	sources;
1039	1039	(4) provide a fair distribution of monetary savings
1040	1040	achieved from the establishment of a universal health coverage
1041	1041	system;
1042	1042	(5) coordinate with existing, ongoing funding sources
1043	1043	from federal and state programs;
1044	1044	(6) be consistent with state and federal requirements
1045	1045	governing financial contributions for persons eligible for
1046	1046	existing public programs;
1047	1047	(7) comply with federal requirements; and
1048	1048	(8) include an exemption for employers and employees
1049	1049	who are subject to a collective bargaining agreement.
1050	1050	(b) The premium commission shall seek expert and legal
1051	1051	advice regarding the best method to structure premium payments
1052	1052	consistent with existing employer-employee health care financing
1053	1053	structures.
1054	1054	Sec. 2003.254. POWERS AND DUTIES. The premium commission
1055	1055	may:
1056	1056	(1) obtain grants from and contract with individuals
1057	1057	and private, local, state, and federal agencies, organizations, and
1058	1058	institutions;
1059	1059	(2) receive gifts, grants, and donations; and
1060	1060	(3) seek structured input from representatives of
1061	1061	stakeholder organizations, policy institutes, and other persons
1062	1062	with expertise in health care, health care financing, or universal
1063	1063	health care models.
1064	1064	Sec. 2003.255. REPORT TO LEGISLATURE. On or before
1065	1065	November 1 of each even-numbered year, the premium commission shall
1066	1066	submit to the governor, the lieutenant governor, and both houses of
1067	1067	the legislature a detailed recommendation for a premium structure.
1068	1068	[Sections 2003.256-2003.300 reserved for expansion]
1069	1069	SUBCHAPTER G. GOVERNMENTAL PAYMENTS
1070	1070	Sec. 2003.301. PAYMENTS FROM FEDERAL GOVERNMENT. (a) The
1071	1071	commission shall seek any waivers, exemptions, agreements, or
1072	1072	legislation necessary to ensure that all federal payments to the
1073	1073	state for health care services are paid directly to the system. The
1074	1074	system shall assume responsibility for all benefits and services
1075	1075	previously paid by the federal government with those funds.
1076	1076	(b) In obtaining the waivers, exemptions, agreements, or
1077	1077	legislation under Subsection (a), the commissioner shall seek from
1078	1078	the federal government a contribution for health care services that
1079	1079	does not decrease in relation to the contribution to other states as
1080	1080	a result of the waivers, exemptions, agreements, or legislation.
1081	1081	Sec. 2003.302. PAYMENTS FROM STATE GOVERNMENTS. (a) The
1082	1082	commission shall seek any waivers, exemptions, agreements, or
1083	1083	legislation necessary to ensure that all state payments for health
1084	1084	care services are paid directly to the system. The system shall
1085	1085	assume responsibility for all benefits and services previously paid
1086	1086	by this state.
1087	1087	(b) The commissioner shall establish formulas for equitable
1088	1088	contributions to the system from each county in this state and other
1089	1089	local governmental entities.
1090	1090	Sec. 2003.303. AGREEMENT WITH ENTITIES CONTRIBUTING TO
1091	1091	FUND. In order to minimize the administrative burden of
1092	1092	maintaining eligibility records for programs transferred to the
1093	1093	system, the commissioner shall attempt to reach an agreement with
1094	1094	federal, state, and local governments in which contributions to the
1095	1095	health coverage fund are fixed to the rate of change of the state
1096	1096	gross domestic product, the size and age of population, and the
1097	1097	number of residents living below the federal poverty level.
1098	1098	Sec. 2003.304. PAYMENTS THROUGH THE MEDICAL ASSISTANCE
1099	1099	PROGRAM. To the extent that federal law allows the transfer of
1100	1100	funding for the medical assistance program under Chapter 31, Human
1101	1101	Resources Code, to the system, the commissioner shall pay from the
1102	1102	health coverage fund all premiums, deductible payments, and
1103	1103	coinsurance for eligible recipients of health benefits under the
1104	1104	medical assistance program under Chapter 31, Human Resources Code.
1105	1105	Sec. 2003.305. MEDICARE PAYMENTS. To the extent that the
1106	1106	commissioner obtains authorization to incorporate Medicare
1107	1107	revenues into the health coverage fund, Medicare Part B payments
1108	1108	that previously were made by individuals or the state shall be paid
1109	1109	by the system for all individuals eligible for both the system and
1110	1110	the Medicare program.
1111	1111	[Sections 2003.306-2003.350 reserved for expansion]
1112	1112	SUBCHAPTER H. FEDERAL PREEMPTION
1113	1113	Sec. 2003.351. WAIVER FOR FEDERAL PREEMPTION. The
1114	1114	commissioner shall pursue all reasonable means to secure a repeal
1115	1115	or a waiver of any provision of federal law that preempts any
1116	1116	provision of this title.
1117	1117	Sec. 2003.352. EMPLOYMENT CONTRACT. (a) To the extent
1118	1118	permitted by federal law, an employee entitled to health or related
1119	1119	benefits under a contract or plan that, under federal law, preempts
1120	1120	provisions of this title, shall first seek benefits under that
1121	1121	contract or plan before receiving benefits from the system.
1122	1122	(b) A benefit may not be denied under the system unless the
1123	1123	employee has failed to take reasonable steps to secure similar
1124	1124	benefits from the contract or plan, if those benefits are
1125	1125	available.
1126	1126	(c) Nothing in this section precludes a person from
1127	1127	receiving benefits from the system that are superior to benefits
1128	1128	available to the person under an existing contract or plan.
1129	1129	(d) This title may not be construed to discourage recourse
1130	1130	to contracts or plans that are protected by federal law.
1131	1131	(e) To the extent permitted by federal law, a health care
1132	1132	provider shall first seek payment from the contract or plan before
1133	1133	submitting a bill to the system.
1134	1134	[Sections 2003.353-2003.400 reserved for expansion]
1135	1135	SUBCHAPTER I. SUBROGATION
1136	1136	Sec. 2003.401. PURPOSE. (a) In this subchapter,
1137	1137	"collateral source" means:
1138	1138	(1) an insurance policy written by an insurer,
1139	1139	including the medical components of automobile, homeowners, and
1140	1140	other forms of insurance;
1141	1141	(2) health care service plans and pension plans;
1142	1142	(3) employers;
1143	1143	(4) employee benefit contracts;
1144	1144	(5) government benefit programs;
1145	1145	(6) a judgment for damages for personal injury; or
1146	1146	(7) a third party who is or may be liable to an
1147	1147	individual for health care services or costs.
1148	1148	(b) Until the role of all other payers for health care
1149	1149	services has been terminated, costs for health care services may be
1150	1150	collected from collateral sources whenever health care services
1151	1151	provided to an individual are covered services under a policy of
1152	1152	insurance, health care service plan, or other collateral source
1153	1153	available to that individual, or for which the individual has a
1154	1154	right of action for compensation to the extent permitted by law.
1155	1155	(c) A collateral source under this section does not include
1156	1156	a contract or plan subject to federal preemption or a governmental
1157	1157	unit, agency, or service. A contract or relationship with a
1158	1158	governmental unit, agency, or service does not exclude an entity
1159	1159	from the obligations of this section.
1160	1160	(d) The commissioner shall attempt to negotiate waivers,
1161	1161	seek federal legislation, or make other arrangements to incorporate
1162	1162	collateral sources in this state into the system.
1163	1163	Sec. 2003.402. NOTIFICATION OF COVERAGE BY COLLATERAL
1164	1164	SOURCE. (a) If an individual receives health care services under
1165	1165	the system and is entitled to coverage, reimbursement, indemnity,
1166	1166	or other compensation from a collateral source, the individual
1167	1167	shall notify the health care provider and provide information
1168	1168	identifying the collateral source, the nature and extent of
1169	1169	coverage or entitlement, and other relevant information.
1170	1170	(b) The health care provider shall forward the information
1171	1171	provided in Subsection (a) to the commissioner. The individual who
1172	1172	receives services under Subsection (a) and who is entitled to
1173	1173	coverage, reimbursement, indemnity, or other compensation from a
1174	1174	collateral source shall provide additional information as
1175	1175	requested by the commissioner.
1176	1176	Sec. 2003.403. SYSTEM REIMBURSEMENT. The system shall seek
1177	1177	reimbursement from the collateral source for services provided to
1178	1178	the individual under Section 2003.402(a) and may institute
1179	1179	appropriate action, including filing suit, to recover the
1180	1180	reimbursement. Upon demand, the collateral source shall pay to the
1181	1181	health coverage fund the sums the collateral source would have paid
1182	1182	or expended on behalf of the individual for the health care services
1183	1183	provided by the system.
1184	1184	Sec. 2003.404. EXEMPT FROM SUBROGATION. If a collateral
1185	1185	source is exempt from subrogation or the obligation to reimburse
1186	1186	the system as provided by this subchapter, the commissioner may
1187	1187	require that an individual who is entitled to health care services
1188	1188	from the source first seek those services from that source before
1189	1189	seeking those services from the system.
1190	1190	SUBTITLE B. TEXAS HEALTH COVERAGE SYSTEM
1191	1191	CHAPTER 2101. ELIGIBILITY
1192	1192	SUBCHAPTER A. GENERAL ELIGIBILITY REQUIREMENTS
1193	1193	Sec. 2101.001. RESIDENTS AND CERTAIN EMPLOYEES ELIGIBLE.
1194	1194	Except as otherwise provided by this chapter, each resident of this
1195	1195	state is eligible for health coverage provided through the system.
1196	1196	Residency is based on physical presence in the state with the intent
1197	1197	to reside.
1198	1198	Sec. 2101.002. UNAUTHORIZED ALIEN INELIGIBLE. (a) A
1199	1199	person who is not lawfully admitted for residence in the United
1200	1200	States is not eligible for health coverage provided through the
1201	1201	system.
1202	1202	(b) To the extent required by federal law, the system shall
1203	1203	provide emergency services to a person otherwise ineligible for
1204	1204	health coverage through the system under this section.
1205	1205	Sec. 2101.003. MILITARY PERSONNEL. United States military
1206	1206	personnel are not eligible for health coverage provided through the
1207	1207	system.
1208	1208	Sec. 2101.004. CERTAIN INMATES. A person covered by a
1209	1209	managed health care plan for persons confined under the
1210	1210	jurisdiction of the Texas Department of Criminal Justice is not
1211	1211	eligible for health coverage provided through the system.
1212	1212	Sec. 2101.005. WORKERS' COMPENSATION. Coverage is not
1213	1213	provided through the system for services covered under a program of
1214	1214	workers' compensation insurance.
1215	1215	[Sections 2101.006-2101.050 reserved for expansion]
1216	1216	SUBCHAPTER B. ELIGIBILITY DETERMINATIONS
1217	1217	Sec. 2101.051. VERIFICATION OF ELIGIBILITY. The
1218	1218	commissioner by rule shall adopt procedures for verifying residence
1219	1219	as necessary to establish eligibility for health coverage provided
1220	1220	through the system.
1221	1221	Sec. 2101.052. RESIDENCE OF MINOR. For purposes of this
1222	1222	chapter, and except as provided by rules of the commissioner, an
1223	1223	unmarried, unemancipated minor has the same residency status as the
1224	1224	minor's parent or managing conservator.
1225	1225	Sec. 2101.053. EVIDENCE OF COVERAGE. The system may issue
1226	1226	an identification card or other evidence of coverage to be used by
1227	1227	an eligible resident to show proof that the resident is eligible for
1228	1228	health coverage provided through the system.
1229	1229	Sec. 2101.054. PRESUMPTION APPLICABLE TO CERTAIN
1230	1230	INDIVIDUALS. A health care facility is entitled to presume that a
1231	1231	person who arrives at the facility and who is unable to provide
1232	1232	proof of eligibility because the person is unconscious, is in need
1233	1233	of emergency services, or is in need of acute psychiatric care is an
1234	1234	eligible resident.
1235	1235	[Sections 2101.055-2101.100 reserved for expansion]
1236	1236	SUBCHAPTER C. SERVICES PROVIDED TO NONRESIDENTS
1237	1237	Sec. 2101.101. PAYMENT OF CLAIMS AUTHORIZED. The system
1238	1238	may, in accordance with rules adopted by the commissioner, pay a
1239	1239	claim for health care services provided to a nonresident who is
1240	1240	temporarily in this state. The nonresident remains liable for the
1241	1241	cost of all services provided to the nonresident through the
1242	1242	system.
1243	1243	CHAPTER 2102. HEALTH CARE SERVICES
1244	1244	SUBCHAPTER A. GENERAL PROVISIONS
1245	1245	Sec. 2102.001. COVERAGE FOR HEALTH CARE SERVICES. The
1246	1246	system must provide coverage for medically necessary health care
1247	1247	services for an eligible resident at at least the level at which
1248	1248	those services were provided under the state acute care Medicaid
1249	1249	program, as that program existed on January 1, 2009.
1250	1250	Sec. 2102.002. LONG-TERM CARE. Notwithstanding Section
1251	1251	2102.001, the system may not provide coverage for long-term care
1252	1252	services.
1253	1253	[Sections 2102.003-2102.050 reserved for expansion]
1254	1254	SUBCHAPTER B. OUT-OF-STATE BENEFITS
1255	1255	Sec. 2102.051. TEMPORARY BENEFITS. The system must provide
1256	1256	health coverage for medically necessary health care services
1257	1257	provided to an eligible resident who is out of this state for a
1258	1258	temporary period not to exceed 90 days.
1259	1259	Sec. 2102.052. ELIGIBILITY. The commissioner by rule shall
1260	1260	establish procedures for verifying eligibility for health coverage
1261	1261	provided through the system under this subchapter.
1262	1262	Sec. 2102.053. EMERGENCY SERVICES. The system shall pay a
1263	1263	claim for emergency services under this subchapter at the usual and
1264	1264	customary rate for those services at the place at which the services
1265	1265	are provided.
1266	1266	Sec. 2102.054. CLAIMS FOR SERVICES OTHER THAN EMERGENCY
1267	1267	SERVICES. The system shall pay a claim for services not under this
1268	1268	subchapter, other than emergency services, at a rate established by
1269	1269	the commissioner.
1270	1270	CHAPTER 2103. BENEFITS
1271	1271	Sec. 2103.001. MEDICAID. A resident who is eligible for
1272	1272	medical assistance program benefits under Chapter 31, Human
1273	1273	Resources Code, is entitled to all benefits available under that
1274	1274	chapter.
1275	1275	Sec. 2103.002. COVERED BENEFITS. (a) Covered benefits
1276	1276	under this chapter include all medical care determined appropriate
1277	1277	by an individual's health care provider, except as provided in
1278	1278	Subsection (c).
1279	1279	(b) Covered benefits under this section include:
1280	1280	(1) inpatient and outpatient health facility
1281	1281	services;
1282	1282	(2) inpatient and outpatient professional health care
1283	1283	provider services by licensed health care professionals;
1284	1284	(3) diagnostic imaging, laboratory services, and
1285	1285	other diagnostic and evaluative services;
1286	1286	(4) durable medical equipment, appliances, and
1287	1287	assistive technology, including prosthetics, eyeglasses, hearing
1288	1288	aids, and repair;
1289	1289	(5) rehabilitative care;
1290	1290	(6) emergency transportation and necessary
1291	1291	transportation for health care services for disabled and indigent
1292	1292	persons;
1293	1293	(7) language interpretation and translation for
1294	1294	health care services, including sign language for those unable to
1295	1295	speak or hear, or who are language impaired, and Braille
1296	1296	translation or other services for those with no or low vision;
1297	1297	(8) child and adult immunizations and preventive care;
1298	1298	(9) health education;
1299	1299	(10) hospice care;
1300	1300	(11) home health care;
1301	1301	(12) prescription drugs listed on the system's
1302	1302	preferred drug list;
1303	1303	(13) nonformulary prescription drugs if standards and
1304	1304	criteria established by the commissioner are met;
1305	1305	(14) mental and behavioral health care;
1306	1306	(15) dental care;
1307	1307	(16) podiatric care;
1308	1308	(17) chiropractic care;
1309	1309	(18) acupuncture;
1310	1310	(19) blood and blood products;
1311	1311	(20) emergency care services;
1312	1312	(21) vision care;
1313	1313	(22) adult day care;
1314	1314	(23) case management and coordination to ensure
1315	1315	services necessary to enable a person to remain safely in the least
1316	1316	restrictive setting;
1317	1317	(24) substance abuse treatment;
1318	1318	(25) care of not more than 100 days in a skilled
1319	1319	nursing facility following hospitalization;
1320	1320	(26) dialysis;
1321	1321	(27) benefits offered by a bona fide church, sect,
1322	1322	denomination, or organization whose principles include healing
1323	1323	entirely by prayer or spiritual means provided by a duly authorized
1324	1324	and accredited practitioner or nurse of that bona fide church,
1325	1325	sect, denomination, or organization;
1326	1326	(28) chronic disease management;
1327	1327	(29) family planning services and supplies, except
1328	1328	services related to an abortion; and
1329	1329	(30) early and periodic screening, diagnosis, and
1330	1330	treatment services, as defined in 42 U.S.C. Section 1396d(r), for
1331	1331	patients younger than 21 years of age, regardless of whether those
1332	1332	services are covered benefits for persons who are at least 21 years
1333	1333	of age.
1334	1334	(c) The following health care services are not covered
1335	1335	benefits under the system:
1336	1336	(1) health care services determined to have no medical
1337	1337	indication by the commissioner and the chief medical officer;
1338	1338	(2) surgery, dermatology, orthodontia, prescription
1339	1339	drugs, or other procedures intended primarily for cosmetic
1340	1340	purposes, unless required to correct a congenital defect, restore
1341	1341	or correct a part of the body altered because of injury, disease, or
1342	1342	surgery, or determined by a health care provider to be medically
1343	1343	necessary;
1344	1344	(3) a private room in an inpatient facility if a
1345	1345	non-private room is available, unless determined to be medically
1346	1346	necessary; and
1347	1347	(4) services of a health care provider or facility
1348	1348	that is not licensed by this state, except for services provided to
1349	1349	a resident who is temporarily out of the state under Section
1350	1350	2102.051.
1351	1351	CHAPTER 2104. COST SHARING
1352	1352	Sec. 2104.001. COPAYMENTS REQUIRED. The finance director,
1353	1353	with the approval of the commissioner, shall establish copayment
1354	1354	amounts to be paid at the point of service by an eligible resident
1355	1355	receiving health care services for which coverage is provided
1356	1356	through the system.
1357	1357	Sec. 2104.002. DEDUCTIBLE AMOUNTS. The finance director,
1358	1358	with the approval of the commissioner, shall establish deductible
1359	1359	amounts that an eligible resident receiving health care services is
1360	1360	responsible to pay before coverage is provided through the system.
1361	1361	Sec. 2104.003. LIMITS ON COPAYMENTS AND DEDUCTIBLES. The
1362	1362	total amount payable for services provided through the system with
1363	1363	respect to an eligible resident, including copayment and deductible
1364	1364	amounts paid under this chapter, may not exceed five percent of the
1365	1365	eligible resident's family income, as determined under rules of the
1366	1366	commissioner.
1367	1367	CHAPTER 2105. HEALTH CARE PROVIDERS
1368	1368	Sec. 2105.001. ANY WILLING PROVIDER. (a) An eligible
1369	1369	resident may select any physician, health care practitioner, or
1370	1370	health care facility to provide medically necessary services within
1371	1371	the scope of the license or other authorization of the physician,
1372	1372	practitioner, or facility if the physician, practitioner, or
1373	1373	facility agrees to accept payment for claims from the system
1374	1374	subject to the terms imposed in accordance with this title.
1375	1375	(b) A physician, health care practitioner, or health care
1376	1376	facility is subject to credentialing under the system in the same
1377	1377	manner as the physician, practitioner, or facility is subject to
1378	1378	the credentialing requirements applicable under the state Medicaid
1379	1379	program as that program existed on January 1, 2009.
1380	1380	Sec. 2105.002. PRIMARY CARE PROVIDER; REQUIRED REFERRAL.
1381	1381	The commissioner by rule shall establish requirements under which
1382	1382	an eligible resident must designate a primary care provider and
1383	1383	must obtain a referral from that provider to obtain coverage for
1384	1384	specialty care services. The system shall use the same methodology
1385	1385	for primary care case management and referral as applicable under
1386	1386	the state Medicaid program as that program existed on January 1,
1387	1387	2009.
1388	1388	ARTICLE 2. CONFORMING AMENDMENTS
1389	1389	SECTION 2.01. Subchapter A, Chapter 531, Government Code,
1390	1390	is amended by adding Section 531.0001 to read as follows:
1391	1391	Sec. 531.0001. COORDINATION WITH TEXAS HEALTH COVERAGE
1392	1392	SYSTEM. (a) Notwithstanding any provision of this chapter or any
1393	1393	other law of this state, on and after January 1, 2012, the Texas
1394	1394	Health Coverage System is responsible for administering the system
1395	1395	for providing health coverage and health care services in this
1396	1396	state.
1397	1397	(b) The Health and Human Services Commission and each health
1398	1398	and human services agency remain responsible for safety and
1399	1399	licensing functions within the jurisdiction of the commission or
1400	1400	the agency before January 1, 2012, but except as provided by
1401	1401	Subsection (c), functions of the commission or agency relating to
1402	1402	the provision of health coverage or health care services are
1403	1403	transferred to the Texas Health Coverage Agency in accordance with
1404	1404	Title 13, Health and Safety Code.
1405	1405	(c) The Health and Human Services Commission and each health
1406	1406	and human services agency remain responsible for long-term care
1407	1407	services provided under the state Medicaid program.
1408	1408	SECTION 2.02. Chapter 30, Insurance Code, is amended by
1409	1409	adding Section 30.005 to read as follows:
1410	1410	Sec. 30.005. COORDINATION WITH TEXAS HEALTH COVERAGE
1411	1411	SYSTEM. Notwithstanding any provision of this code or any other law
1412	1412	of this state, on and after January 1, 2012, an insurer, health
1413	1413	maintenance organization, or other entity may not offer a health
1414	1414	benefits plan in this state to the extent that plan duplicates
1415	1415	coverage provided under the Texas Health Coverage System.
1416	1416	ARTICLE 3. TRANSITION PLAN
1417	1417	SECTION 3.01. Not later than October 1, 2009, the governor
1418	1418	shall appoint the commissioner of health coverage in accordance
1419	1419	with Chapter 2002, Health and Safety Code, as added by this Act.
1420	1420	SECTION 3.02. (a) Not later than January 1, 2010, the
1421	1421	commissioner of health coverage shall appoint a transition advisory
1422	1422	group. The transition advisory group must include representatives
1423	1423	of the public, the health care industry, and issuers of health
1424	1424	benefit plans and other experts identified by the commissioner.
1425	1425	(b) In consultation with the transition advisory group, the
1426	1426	commissioner of health coverage shall develop a plan for the
1427	1427	orderly implementation of Title 13, Health and Safety Code, as
1428	1428	added by this Act. The plan must include provisions to assist
1429	1429	individuals who lose employment, directly or indirectly, as a
1430	1430	result of the implementation of the system.
1431	1431	SECTION 3.03. The Texas Health Coverage System shall become
1432	1432	effective to provide coverage in accordance with Title 13, Health
1433	1433	and Safety Code, as added by this Act, not later than January 1,
1434	1434	2012.
1435	1435	SECTION 3.04. (a) In this section, "affected state agency"
1436	1436	means:
1437	1437	(1) the Health and Human Services Commission;
1438	1438	(2) the Texas Department of Insurance;
1439	1439	(3) the Department of State Health Services;
1440	1440	(4) the Department of Assistive and Rehabilitative
1441	1441	Services;
1442	1442	(5) the Department of Aging and Disability Services;
1443	1443	(6) the Department of Family and Protective Services;
1444	1444	(7) the Employees Retirement System of Texas;
1445	1445	(8) the Teacher Retirement System of Texas;
1446	1446	(9) The Texas A&M University System; and
1447	1447	(10) The University of Texas System.
1448	1448	(b) Effective January 1, 2012, or on an earlier date
1449	1449	specified by the commissioner of health coverage:
1450	1450	(1) the property and records of each affected state
1451	1451	agency related to the administration of health coverage, health
1452	1452	benefits, or health care services within the jurisdiction of the
1453	1453	Texas Health Coverage Agency are transferred to the Texas Health
1454	1454	Coverage Agency to assist that agency in beginning to administer
1455	1455	Title 13, Health and Safety Code, as added by this Act, as
1456	1456	efficiently as practicable;
1457	1457	(2) all powers, duties, functions, activities,
1458	1458	obligations, rights, contracts, records, property, and
1459	1459	appropriations or other money of the affected state agency related
1460	1460	to the administration of health coverage, health benefits, or
1461	1461	health care services within the jurisdiction of the Texas Health
1462	1462	Coverage Agency are transferred to the Texas Health Coverage
1463	1463	Agency;
1464	1464	(3) a rule or form adopted by each affected state
1465	1465	agency related to the administration of health coverage, health
1466	1466	benefits, or health care services within the jurisdiction of the
1467	1467	Texas Health Coverage Agency is a rule or form of the Texas Health
1468	1468	Coverage Agency and remains in effect until altered by that agency;
1469	1469	and
1470	1470	(4) a reference in law or an administrative rule to an
1471	1471	affected state agency that relates to the administration of health
1472	1472	coverage, health benefits, or health care services within the
1473	1473	jurisdiction of the Texas Health Coverage Agency means the Texas
1474	1474	Health Coverage Agency.
1475	1475	(c) An employee of an affected state agency employed on the
1476	1476	effective date of this Act who performs a function that relates to
1477	1477	the administration of health coverage, health benefits, or health
1478	1478	care services within the jurisdiction of the Texas Health Coverage
1479	1479	Agency does not automatically become an employee of the Texas
1480	1480	Health Coverage Agency. To become an employee of the Texas Health
1481	1481	Coverage Agency, a person must apply for a position at the Texas
1482	1482	Health Coverage Agency. In establishing the Texas Health Coverage
1483	1483	Agency in accordance with the transition plan developed under
1484	1484	Section 3.02 of this Act, the Texas Health Coverage Agency shall
1485	1485	give preference in employment to employees described by this
1486	1486	subsection who have the necessary qualifications for employment
1487	1487	with the Texas Health Coverage Agency.
1488	1488	(d) Until the date of the transfer specified by Subsection
1489	1489	(b) of this section, and subject to the transition plan developed
1490	1490	under Section 3.02 of this Act, each affected state agency shall
1491	1491	continue to exercise the powers and perform the duties assigned to
1492	1492	the state agency under the law as it existed immediately before the
1493	1493	effective date of this Act or as modified by another Act of the 81st
1494	1494	Legislature, Regular Session, 2009, that becomes law, and the
1495	1495	former law is continued in effect for that purpose.
1496	1496	ARTICLE 4. EFFECTIVE DATE
1497	1497	SECTION 4.01. This Act takes effect immediately if it
1498	1498	receives a vote of two-thirds of all the members elected to each
1499	1499	house, as provided by Section 39, Article III, Texas Constitution.
1500	1500	If this Act does not receive the vote necessary for immediate
1501	1501	effect, this Act takes effect September 1, 2009.