By: Thompson of Harris H.B. No. 2819
A BILL TO BE ENTITLED
AN ACT
relating to establishing a demonstration project for preventative
health care services, and implementation of related outreach
activities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0248 to read as follows:
Sec. 32.0248. DEMONSTRATION PROJECT FOR WOMEN'S HEALTH CARE
SERVICES. (a) The department shall operate a demonstration
project through the medical assistance program to expand access to
preventive health and family planning services for women. A person
eligible to participate in the demonstration project may receive
appropriate preventive health and family planning services,
including:
(1) medical history recording and evaluation;
(2) physical examinations;
(3) health screenings, including screening for:
(A) diabetes;
(B) cervical cancer;
(C) breast cancer;
(D) sexually transmitted diseases and
infections;
(E) hypertension;
(F) cholesterol; and
(G) tuberculosis;
(4) counseling and education on contraceptive methods
emphasizing the health benefits of abstinence from sexual activity
to recipients who are not married;
(5) provision of contraceptives; and
(6) risk assessment.
(b) A person is eligible to participate in the demonstration
project if the person:
(1) has a net family income that is at or below 185
percent of the federal poverty level and:
(A) is at least 18 years of age; or
(B) is younger than 18 years of age and has given
birth while receiving benefits under the medical assistance
program;
(2) is a woman who is at least 18 years of age and
participates in or receives benefits under any of the following:
(A) the medical assistance program;
(B) the financial assistance program under
Chapter 31;
(C) the nutritional assistance program under
Chapter 33;
(D) the Supplemental Food Program for Women,
Infants and Children; or
(E) another program administered by the state
that:
(i) requires documentation of income; and
(ii) restricts eligibility to persons with
income equal to or less than the income eligibility guidelines
applicable to the medical assistance program;
(3) is a woman who is at least 18 years of age and is
presumed eligible for one of the programs listed in Subdivision (2)
pending completion of that program's eligibility process; or
(4) is a woman who is at least 18 years of age and is a
member of a family that contains at least one person who
participates in or receives benefits under one of the programs
listed in Subdivision (2)); or
(5) is a woman who is not pregnant but who, if she were
to become pregnant, would have a net family income on the birth of
the child that is at or below 185 percent of the federal poverty
level.
(b-1) The department shall identify women potentially
eligible for participation in the demonstration project following
pregnancies for which the women received benefits through the
medical assistance program and assist those women in establishing
eligibility for the demonstration project immediately after their
eligibility for postpartum coverage under the medical assistance
program terminates.
(b-2) The department shall modify any applicable
administrative procedures to ensure that to the extent possible a
woman described by Subsection (b-1) maintains continuous
eligibility for any services provided by both the medical
assistance program and the demonstration project during the
transition from participation in the medical assistance program to
participation in the demonstration project.
(c) The department shall ensure that the standards of care
provided to a woman participating in the demonstration project are
consistent with the requirements of law and current best practices
for provision of public health services.
(d) The department shall develop procedures for determining
and certifying eligibility for services under the demonstration
project at the point of service delivery using integrated
procedures that minimize duplication of effort by providers, the
department, and other state agencies. The department may not use a
procedure that would require a cost in excess of 10 percent of the
total costs of actual preventive health and family planning
services provided under the demonstration project. The eligibility
procedure may provide for expedited determination and
certification using a simplified form requiring only family income
and family size.
(e) The department shall compile a list of potential funding
sources a person participating in the demonstration project may be
able to use to help pay for treatment for health problems:
(1) identified using services provided under the
demonstration project; and
(2) for which the person is not eligible to receive
treatment under the medical assistance program or the demonstration
project.
(f) Providers of services under the demonstration project
shall comply with requests made by the department for information
necessary for the department to:
(1) make efficient use of money spent for the
operation and administration of the demonstration project;
(2) report and provide information required by federal
law; and
(3) compile the report required by Subsection (g).
(g) Not later than December 1 of each even-numbered year,
the department shall submit a report to the legislature regarding
the department's progress in establishing and operating the
demonstration project; including:
(1) the number of persons receiving services under
this program;
(2) the number of providers participating in this
program;
(3) the geographic service areas covered by the
providers; and
(4) the projected and extrapolated cost saving fiscal
impact to the state.
(h) Any program under this subchapter or any medical
assistance program operated or administered by the Department must
comply with the requirement set forth in Section 1902(a)(23) of
Title XIX of the Social Security Act and allow any person that is
eligible for medical assistance to receive services from any
willing provider that is qualified to perform the services needed.
SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.02481 to read as follows:
Sec. 32.02481. PREVENTIVE HEALTH PROGRAM OUTREACH. (a) In
this section, "preventive health and family planning program" means
the demonstration project established under Section 32.0248.
(b) The department shall develop and implement an outreach
program to assist women described by Section 32.0248(b-1) in
establishing eligibility for the preventive health and family
planning program. As part of the outreach program, the department
shall:
(1) perform an initial screening to determine
eligibility for the preventive health and family planning program;
and
(2) ensure that a woman described by Section
32.0248(b-1) receives information regarding benefits available
through the preventive health and family planning program,
notification of potential eligibility, an application form for the
preventive health and family planning program, information on where
and how to receive application assistance, and a list, updated on a
quarterly basis, of preventive health and family planning program
providers in the woman's county of residence.
(c) Information required under Subsection (b)(2) may be
included in other mailings regularly sent to recipients, including
a letter informing a recipient of the recipient's eligibility for
medical assistance.
(d) A hospital or health plan participating in the outreach
program that contracts with an entity that provides information
and services to participants in the medical assistance program may
modify the information and services provided by that entity to
ensure that potentially eligible women are provided the information
and services required under this section.
(e) The outreach program must include monitoring,
evaluation, and reporting. The department shall use information
provided by hospitals or health plans participating in the
outreach program to report to the legislature regarding:
(1) the costs and benefits of establishing the
outreach program; and
(2) problems encountered during the implementation
and operation of the outreach program and recommendations for
solutions.
SECTION 3. The change in law made by this Act applies to a
person who receives medical assistance under Chapter 32, Human
Resources Code, on or after the effective date of this Act,
regardless of the date on which eligibility for the medical
assistance was determined.
SECTION 4. If before implementing Section 32.0248, Human
Resources Code, as amended by this Act, a state agency determines
that an amendment to the existing waiver or other authorization is
necessary to extend the operation and scope of the demonstration
project under that section as amended, the agency affected by the
provision shall request the amendment to the waiver or other
authorization and may delay implementing that section until the
amendment or other authorization is granted.
SECTION 5. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 6. Not later than January 1, 2014, the state agency
responsible for implementing the demonstration project required by
Section 32.0248, Human Resources Code, as added by this Act, shall
implement the demonstration project.
SECTION 7. 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, 2013.