By: Kolkhorst, King of Taylor, Truitt, H.B. No. 13
Zerwas
A BILL TO BE ENTITLED
AN ACT
relating to the Medicaid program and alternate methods of providing
health services to low-income persons in this state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 536 to read as follows:
CHAPTER 536. MEDICAID REFORM WAIVER
Sec. 536.001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
Sec. 536.002. FEDERAL AUTHORIZATION FOR MEDICAID REFORM.
(a) The executive commissioner shall seek a waiver under Section
1115 of the federal Social Security Act (42 U.S.C. Section 1315) to
the state Medicaid plan.
(b) The waiver under this section must be designed to
achieve the following objectives regarding the Medicaid program and
alternatives to the program:
(1) provide flexibility consistent with federal law to
determine Medicaid eligibility categories and income levels;
(2) provide flexibility to design Medicaid benefits
that meet the demographic, public health, clinical, and cultural
needs of this state or regions within this state;
(3) encourage use of the private health benefits
coverage market rather than public benefits systems;
(4) encourage people who have access to private
employer-based health benefits to obtain or maintain those
benefits;
(5) create a culture of shared financial
responsibility, accountability, and participation in the Medicaid
program by:
(A) establishing and enforcing copayment
requirements similar to private sector principles for all
eligibility groups;
(B) promoting the use of health savings accounts
to influence a culture of individual responsibility; and
(C) promoting the use of vouchers for
consumer-directed services in which consumers manage and pay for
health-related services provided to them using program vouchers;
(6) consolidate federal funding streams, including
funds from the disproportionate share hospitals and upper payment
limit supplemental payment programs and other federal Medicaid
funds, to ensure the most effective and efficient use of those
funding streams;
(7) allow flexibility in the use of state funds used to
obtain federal matching funds, including allowing the use of
intergovernmental transfers, certified public expenditures, costs
not otherwise matchable, or other funds and funding mechanisms to
obtain federal matching funds;
(8) empower individuals who are uninsured to acquire
health benefits coverage through the promotion of cost-effective
coverage models that provide access to affordable primary,
preventive, and other health care on a sliding scale, with fees paid
at the point of service;
(9) allow for the redesign of long-term care services
and supports to increase access to person-centered care in the most
cost-effective manner;
(10) create the Texas Health Insurance Virtual
Marketplace, a virtual marketplace based on an Internet portal that
allows people to shop, compare, and purchase private health
benefits coverage;
and
(11) allow for unmatched municipal and county
government funds or expenditures to serve as the state portion
under a federal matching program for the provision of mental health
services to eligible individuals.
SECTION 2. (a) In this section:
(1) "Commission" means the Health and Human Services
Commission.
(2) "FMAP" means the federal medical assistance
percentage by which state expenditures under the Medicaid program
are matched with federal funds.
(3) "Illegal immigrant" means an individual who is not
a citizen or national of the United States and who is unlawfully
present in the United States.
(4) "Medicaid program" means the medical assistance
program under Chapter 32, Human Resources Code.
(b) The commission shall actively pursue a modification to
the formula prescribed by federal law for determining this state's
FMAP to achieve a formula that would produce an FMAP that accounts
for and is periodically adjusted to reflect changes in the
following factors in this state:
(1) the total population;
(2) the population growth rate; and
(3) the percentage of the population with household
incomes below the federal poverty level.
(c) The commission shall pursue the modification as
required by Subsection (b) of this section by providing to the Texas
delegation to the United States Congress and the federal Centers
for Medicare and Medicaid Services and other appropriate federal
agencies data regarding the factors listed in that subsection and
information indicating the effects of those factors on the Medicaid
program that are unique to this state.
(d) In addition to the modification to the FMAP described by
Subsection (b) of this section, the commission shall make efforts
to obtain additional federal Medicaid funding for Medicaid services
required to be provided to illegal immigrants in this state. As
part of that effort, the commission shall provide to the Texas
delegation to the United States Congress and the federal Centers
for Medicare and Medicaid Services and other appropriate federal
agencies data regarding the costs to this state of providing those
services.
(e) This section expires September 1, 2013.
SECTION 3. (a) The Medicaid Reform Waiver Legislative
Oversight Committee is created to facilitate the reform waiver
efforts with respect to Medicaid.
(b) The committee is composed of eight members, as follows:
(1) four members of the senate, appointed by the
lieutenant governor not later than October 1, 2011; and
(2) four members of the house of representatives,
appointed by the speaker of the house of representatives not later
than October 1, 2011.
(c) A member of the committee serves at the pleasure of the
appointing official.
(d) The lieutenant governor shall designate a member of the
committee as the presiding officer.
(e) A member of the committee may not receive compensation
for serving on the committee but is entitled to reimbursement for
travel expenses incurred by the member while conducting the
business of the committee as provided by the General Appropriations
Act.
(f) The committee shall:
(1) facilitate the design and development of the
Medicaid reform waiver required by Chapter 536, Government Code, as
added by this Act;
(2) facilitate a smooth transition from existing
Medicaid payment systems and benefit designs to a new model of
Medicaid enabled by the waiver described by Subdivision (1) of this
subsection;
(3) meet at the call of the presiding officer; and
(4) research, take public testimony, and issue reports
requested by the lieutenant governor or speaker of the house of
representatives.
(g) The committee may request reports and other information
from the Health and Human Services Commission.
(h) The committee shall use existing staff of the senate,
the house of representatives, and the Texas Legislative Council to
assist the committee in performing its duties under this section.
(i) Chapter 551, Government Code, applies to the committee.
(j) The committee shall report to the lieutenant governor
and speaker of the house of representatives not later than November
15, 2012. The report must include:
(1) identification of significant issues that impede
the transition to a more effective Medicaid program;
(2) the measures of effectiveness associated with
changes to the Medicaid program;
(3) the impact of Medicaid changes on safety net
hospitals and other significant traditional providers; and
(4) the impact on the uninsured in Texas.
(k) This section expires September 1, 2013, and the
committee is abolished on that date.
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, 2011.