S.B. No. 8
AN ACT
relating to the provision and delivery of certain health and human
services in this state, including the provision of those services
through the Medicaid program and the prevention of fraud, waste,
and abuse in that program and other programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 531, Government Code, is
amended by adding Section 531.0082 to read as follows:
Sec. 531.0082. DATA ANALYSIS UNIT. (a) The executive
commissioner shall establish a data analysis unit within the
commission to establish, employ, and oversee data analysis
processes designed to:
(1) improve contract management;
(2) detect data trends; and
(3) identify anomalies relating to service
utilization, providers, payment methodologies, and compliance with
requirements in Medicaid and child health plan program managed care
and fee-for-service contracts.
(b) The commission shall assign staff to the data analysis
unit who perform duties only in relation to the unit.
(c) The data analysis unit shall use all available data and
tools for data analysis when establishing, employing, and
overseeing data analysis processes under this section.
(d) Not later than the 30th day following the end of each
calendar quarter, the data analysis unit shall provide an update on
the unit's activities and findings to the governor, the lieutenant
governor, the speaker of the house of representatives, the chair of
the Senate Finance Committee, the chair of the House Appropriations
Committee, and the chairs of the standing committees of the senate
and house of representatives having jurisdiction over the Medicaid
program.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02115 to read as follows:
Sec. 531.02115. MARKETING ACTIVITIES BY PROVIDERS
PARTICIPATING IN MEDICAID OR CHILD HEALTH PLAN PROGRAM. (a) A
provider participating in the Medicaid or child health plan
program, including a provider participating in the network of a
managed care organization that contracts with the commission to
provide services under the Medicaid or child health plan program,
may not engage in any marketing activity, including any
dissemination of material or other attempt to communicate, that:
(1) involves unsolicited personal contact, including
by door-to-door solicitation, solicitation at a child-care
facility or other type of facility, direct mail, or telephone, with
a Medicaid client or a parent whose child is enrolled in the
Medicaid or child health plan program;
(2) is directed at the client or parent solely because
the client or the parent's child is receiving benefits under the
Medicaid or child health plan program; and
(3) is intended to influence the client's or parent's
choice of provider.
(b) In addition to the requirements of Subsection (a), a
provider participating in the network of a managed care
organization described by that subsection must comply with the
marketing guidelines established by the commission under Section
533.008.
(c) Nothing in this section prohibits:
(1) a provider participating in the Medicaid or child
health plan program from:
(A) engaging in a marketing activity, including
any dissemination of material or other attempt to communicate, that
is intended to influence the choice of provider by a Medicaid client
or a parent whose child is enrolled in the Medicaid or child health
plan program, if the marketing activity:
(i) is conducted at a community-sponsored
educational event, health fair, outreach activity, or other similar
community or nonprofit event in which the provider participates and
does not involve unsolicited personal contact or promotion of the
provider's practice; or
(ii) involves only the general
dissemination of information, including by television, radio,
newspaper, or billboard advertisement, and does not involve
unsolicited personal contact;
(B) as permitted under the provider's contract,
engaging in the dissemination of material or another attempt to
communicate with a Medicaid client or a parent whose child is
enrolled in the Medicaid or child health plan program, including
communication in person or by direct mail or telephone, for the
purpose of:
(i) providing an appointment reminder;
(ii) distributing promotional health
materials;
(iii) providing information about the types
of services offered by the provider; or
(iv) coordinating patient care; or
(C) engaging in a marketing activity that has
been submitted for review and obtained a notice of prior
authorization from the commission under Subsection (d); or
(2) a provider participating in the Medicaid STAR +
PLUS program from, as permitted under the provider's contract,
engaging in a marketing activity, including any dissemination of
material or other attempt to communicate, that is intended to
educate a Medicaid client about available long-term care services
and supports.
(d) The commission shall establish a process by which
providers may submit proposed marketing activities for review and
prior authorization to ensure that providers are in compliance with
the requirements of this section and, if applicable, Section
533.008, or to determine whether the providers are exempt from a
requirement of this section and, if applicable, Section 533.008.
The commission may grant or deny a provider's request for
authorization to engage in a proposed marketing activity.
(e) The executive commissioner shall adopt rules as
necessary to implement this section, including rules relating to
provider marketing activities that are exempt from the requirements
of this section and, if applicable, Section 533.008.
SECTION 3. Section 531.02414, Government Code, is amended
by amending Subsection (d) and adding Subsections (g) and (h) to
read as follows:
(d) Subject to Section 533.00257, the [The] commission may
contract with a public transportation provider, as defined by
Section 461.002, Transportation Code, a private transportation
provider, or a regional transportation broker for the provision of
public transportation services, as defined by Section 461.002,
Transportation Code, under the medical transportation program.
(g) The commission shall enter into a memorandum of
understanding with the Texas Department of Motor Vehicles and the
Department of Public Safety for purposes of obtaining the motor
vehicle registration and driver's license information of a provider
of medical transportation services, including a regional
contracted broker and a subcontractor of the broker, to confirm
that the provider complies with applicable requirements adopted
under Subsection (e).
(h) The commission shall establish a process by which
providers of medical transportation services, including providers
under a managed transportation delivery model, that contract with
the commission may request and obtain the information described
under Subsection (g) for purposes of ensuring that subcontractors
providing medical transportation services meet applicable
requirements adopted under Subsection (e).
SECTION 4. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.076 to read as follows:
Sec. 531.076. REVIEW OF PRIOR AUTHORIZATION AND UTILIZATION
REVIEW PROCESSES. (a) The commission shall periodically review in
accordance with an established schedule the prior authorization and
utilization review processes within the Medicaid fee-for-service
delivery model to determine if those processes need modification to
reduce authorizations of unnecessary services and inappropriate
use of services. The commission shall also monitor the processes
described in this subsection for anomalies and, on identification
of an anomaly in a process, shall review the process for
modification earlier than scheduled.
(b) The commission shall monitor Medicaid managed care
organizations to ensure that the organizations are using prior
authorization and utilization review processes to reduce
authorizations of unnecessary services and inappropriate use of
services.
SECTION 5. Section 531.102, Government Code, is amended by
amending Subsection (a) and adding Subsection (l) to read as
follows:
(a) The [commission, through the] commission's office of
inspector general[,] is responsible for the prevention, detection,
audit, inspection, review, and investigation of fraud, waste, and
abuse in the provision and delivery of all health and human services
in the state, including services through any state-administered
health or human services program that is wholly or partly federally
funded, and the enforcement of state law relating to the provision
of those services. The commission may obtain any information or
technology necessary to enable the office to meet its
responsibilities under this subchapter or other law.
(l) Nothing in this section limits the authority of any
other state agency or governmental entity.
SECTION 6. Subchapter C, Chapter 531, Government Code, is
amended by adding Section 531.1022 to read as follows:
Sec. 531.1022. PEACE OFFICERS. (a) The commission's
office of inspector general shall employ and commission not more
than five peace officers at any given time for the purpose of
assisting the office in carrying out the duties of the office
relating to the investigation of fraud, waste, and abuse in the
Medicaid program.
(b) Peace officers employed under this section are
administratively attached to the Department of Public Safety. The
commission shall provide administrative support to the department
necessary to support the assignment of peace officers employed
under this section.
(c) A peace officer employed and commissioned by the office
under this section is a peace officer for purposes of Article 2.12,
Code of Criminal Procedure.
(d) A peace officer employed and commissioned under this
section shall obtain prior approval from the office of attorney
general before carrying out any duties requiring peace officer
status.
SECTION 7. (a) Subchapter A, Chapter 533, Government Code,
is amended by adding Section 533.00257 to read as follows:
Sec. 533.00257. DELIVERY OF MEDICAL TRANSPORTATION PROGRAM
SERVICES. (a) In this section:
(1) "Managed transportation organization" means:
(A) a rural or urban transit district created
under Chapter 458, Transportation Code;
(B) a public transportation provider defined by
Section 461.002, Transportation Code;
(C) a regional contracted broker defined by
Section 531.02414;
(D) a local private transportation provider
approved by the commission to provide Medicaid nonemergency medical
transportation services; or
(E) any other entity the commission determines
meets the requirements of this section.
(2) "Medical transportation program" has the meaning
assigned by Section 531.02414.
(3) "Transportation service area provider" means a
for-profit or nonprofit entity or political subdivision of this
state that provides demand response, curb-to-curb, nonemergency
transportation under the medical transportation program.
(b) Subject to Subsection (i), the commission shall provide
medical transportation program services on a regional basis through
a managed transportation delivery model using managed
transportation organizations and providers, as appropriate, that:
(1) operate under a capitated rate system;
(2) assume financial responsibility under a full-risk
model;
(3) operate a call center;
(4) use fixed routes when available and appropriate;
and
(5) agree to provide data to the commission if the
commission determines that the data is required to receive federal
matching funds.
(c) The commission shall procure managed transportation
organizations under the medical transportation program through a
competitive bidding process for each managed transportation region
as determined by the commission.
(d) A managed transportation organization that participates
in the medical transportation program must attempt to contract with
medical transportation providers that:
(1) are considered significant traditional providers,
as defined by rule by the executive commissioner;
(2) meet the minimum quality and efficiency measures
required under Subsection (g) and other requirements that may be
imposed by the managed transportation organization; and
(3) agree to accept the prevailing contract rate of
the managed transportation organization.
(e) To the extent allowed under federal law, a managed
transportation organization may own, operate, and maintain a fleet
of vehicles or contract with an entity that owns, operates, and
maintains a fleet of vehicles. The commission shall seek
appropriate federal waivers or other authorizations to implement
this subsection as necessary.
(f) The commission shall consider the ownership, operation,
and maintenance of a fleet of vehicles by a managed transportation
organization to be a related-party transaction for purposes of
applying experience rebates, administrative costs, and other
administrative controls determined by the commission.
(g) The commission shall require that managed
transportation organizations and providers participating in the
medical transportation program meet minimum quality and efficiency
measures as determined by the commission.
(h) The commission may contract with transportation service
area providers providing services under the medical transportation
program on September 1, 2013, in not more than three contiguous
rural or small urban transit districts located within a managed
transportation region to execute appropriate interlocal agreements
to consolidate and coordinate medical transportation program
service delivery activities within the area served by the providers
for the evaluation of:
(1) cost-savings measures;
(2) efficiencies;
(3) best practices; and
(4) available matching funds.
(i) The commission may delay providing medical
transportation program services through a managed transportation
delivery model in areas of this state in which the commission on
September 1, 2013, is operating a full-risk transportation broker
model.
(j) Notwithstanding Subsection (i), the commission may not
delay providing medical transportation program services through a
managed transportation delivery model in:
(1) a county with a population of 750,000 or more:
(A) in which all or part of a municipality with a
population of one million or more is located; and
(B) that is located adjacent to a county with a
population of two million or more; or
(2) a county with a population of at least 55,000 but
not more than 65,000 that is located adjacent to a county with a
population of at least 500,000 but not more than 1.5 million.
(k) Subsection (h) and this subsection expire August 31,
2015.
(b) The Health and Human Services Commission shall begin
providing medical transportation program services through the
delivery model required by Section 533.00257, Government Code, as
added by this section, not later than September 1, 2014, subject to
Subsection (i), Section 533.00257, Government Code, as added by
this section.
SECTION 8. Subsection (a-1), Section 533.005, Government
Code, is amended to read as follows:
(a-1) The requirements imposed by Subsections (a)(23)(A),
(B), and (C) do not apply, and may not be enforced, on and after
August 31, 2018 [2013].
SECTION 9. (a) Section 773.0571, Health and Safety Code, is
amended to read as follows:
Sec. 773.0571. REQUIREMENTS FOR PROVIDER LICENSE. The
department shall issue to an emergency medical services provider
applicant a license that is valid for two years if the department is
satisfied that:
(1) the applicant [emergency medical services
provider] has adequate staff to meet the staffing standards
prescribed by this chapter and the rules adopted under this
chapter;
(2) each emergency medical services vehicle is
adequately constructed, equipped, maintained, and operated to
render basic or advanced life support services safely and
efficiently;
(3) the applicant [emergency medical services
provider] offers safe and efficient services for emergency
prehospital care and transportation of patients; [and]
(4) the applicant:
(A) possesses sufficient professional experience
and qualifications to provide emergency medical services; and
(B) has not been excluded from participation in
the state Medicaid program;
(5) the applicant holds a letter of approval issued
under Section 773.0573 by the governing body of the municipality or
the commissioners court of the county in which the applicant is
located and is applying to provide emergency medical services, as
applicable;
(6) the applicant employs a medical director; and
(7) the applicant [emergency medical services
provider] complies with the rules adopted [by the board] under this
chapter.
(b) Subchapter C, Chapter 773, Health and Safety Code, is
amended by adding Sections 773.05711, 773.05712, and 773.05713 to
read as follows:
Sec. 773.05711. ADDITIONAL EMERGENCY MEDICAL SERVICES
PROVIDER LICENSE REQUIREMENTS. (a) In addition to the
requirements for obtaining or renewing an emergency medical
services provider license under this subchapter, a person who
applies for a license or for a renewal of a license must:
(1) provide the department with a letter of credit
issued by a federally insured bank or savings institution in the
amount of:
(A) $100,000 for the initial license and for
renewal of the license on the second anniversary of the date the
initial license is issued;
(B) $75,000 for renewal of the license on the
fourth anniversary of the date the initial license is issued;
(C) $50,000 for renewal of the license on the
sixth anniversary of the date the initial license is issued; and
(D) $25,000 for renewal of the license on the
eighth anniversary of the date the initial license is issued;
(2) if the applicant participates in the medical
assistance program operated under Chapter 32, Human Resources Code,
the Medicaid managed care program operated under Chapter 533,
Government Code, or the child health plan program operated under
Chapter 62 of this code, provide the Health and Human Services
Commission with a surety bond in the amount of $50,000; and
(3) submit for approval by the department the name and
contact information of the provider's administrator of record who
satisfies the requirements under Section 773.05712.
(b) An emergency medical services provider that is directly
operated by a governmental entity is exempt from this section.
Sec. 773.05712. ADMINISTRATOR OF RECORD. (a) The
administrator of record for an emergency medical services provider
licensed under this subchapter:
(1) may not be employed or otherwise compensated by
another private for-profit emergency medical services provider;
(2) must meet the qualifications required for an
emergency medical technician or other health care professional
license or certification issued by this state; and
(3) must submit to a criminal history record check at
the applicant's expense.
(b) Section 773.0415 does not apply to information an
administrator of record is required to provide under this section.
(c) An administrator of record initially approved by the
department may be required to complete an education course for new
administrators of record. The executive commissioner shall
recognize, prepare, or administer the education course for new
administrators of record, which must include information about the
laws and department rules that affect emergency medical services
providers.
(d) An administrator of record approved by the department
under Section 773.05711(a) annually must complete at least eight
hours of continuing education following initial approval. The
executive commissioner shall recognize, prepare, or administer
continuing education programs for administrators of record, which
must include information about changes in law and department rules
that affect emergency medical services providers.
(e) Subsection (a)(2) does not apply to an emergency medical
services provider that held a license on September 1, 2013, and has
an administrator of record who has at least eight years of
experience providing emergency medical services.
(f) An emergency medical services provider that is directly
operated by a governmental entity is exempt from this section.
Sec. 773.05713. REPORT TO LEGISLATURE. Not later than
December 1 of each even-numbered year, the department shall
electronically submit a report to the lieutenant governor, the
speaker of the house of representatives, and the standing
committees of the house and senate with jurisdiction over the
department on the effect of Sections 773.05711 and 773.05712 that
includes:
(1) the total number of applications for emergency
medical services provider licenses submitted to the department and
the number of applications for which licenses were issued or
licenses were denied by the department;
(2) the number of emergency medical services provider
licenses that were suspended or revoked by the department for
violations of those sections and a description of the types of
violations that led to the license suspension or revocation;
(3) the number of occurrences and types of fraud
committed by licensed emergency medical services providers related
to those sections;
(4) the number of complaints made against licensed
emergency medical services providers for violations of those
sections and a description of the types of complaints; and
(5) the status of any coordination efforts of the
department and the Texas Medical Board related to those sections.
(c) Subchapter C, Chapter 773, Health and Safety Code, is
amended by adding Section 773.0573 to read as follows:
Sec. 773.0573. LETTER OF APPROVAL FROM LOCAL GOVERNMENTAL
ENTITY. (a) An emergency medical services provider applicant must
obtain a letter of approval from:
(1) the governing body of the municipality in which
the applicant is located and is applying to provide emergency
medical services; or
(2) if the applicant is not located in a municipality,
the commissioners court of the county in which the applicant is
located and is applying to provide emergency medical services.
(b) A governing body of a municipality or a commissioners
court of a county may issue a letter of approval to an emergency
medical services provider applicant who is applying to provide
emergency medical services in the municipality or county only if
the governing body or commissioners court determines that:
(1) the addition of another licensed emergency medical
services provider will not interfere with or adversely affect the
provision of emergency medical services by the licensed emergency
medical services providers operating in the municipality or county;
(2) the addition of another licensed emergency medical
services provider will remedy an existing provider shortage that
cannot be resolved through the use of the licensed emergency
medical services providers operating in the municipality or county;
and
(3) the addition of another licensed emergency medical
services provider will not cause an oversupply of licensed
emergency medical services providers in the municipality or county.
(c) An emergency medical services provider is prohibited
from expanding operations to or stationing any emergency medical
services vehicles in a municipality or county other than the
municipality or county from which the provider obtained the letter
of approval under this section until after the second anniversary
of the date the provider's initial license was issued, unless the
expansion or stationing occurs in connection with:
(1) a contract awarded by another municipality or
county for the provision of emergency medical services;
(2) an emergency response made in connection with an
existing mutual aid agreement; or
(3) an activation of a statewide emergency or disaster
response by the department.
(d) This section does not apply to:
(1) renewal of an emergency medical services provider
license; or
(2) a municipality, county, emergency services
district, hospital, or emergency medical services volunteer
provider organization in this state that applies for an emergency
medical services provider license.
(d) Subchapter C, Chapter 773, Health and Safety Code, is
amended by adding Section 773.06141 to read as follows:
Sec. 773.06141. SUSPENSION, REVOCATION, OR DENIAL OF
EMERGENCY MEDICAL SERVICES PROVIDER LICENSE. (a) The
commissioner may suspend, revoke, or deny an emergency medical
services provider license on the grounds that the provider's
administrator of record, employee, or other representative:
(1) has been convicted of, or placed on deferred
adjudication community supervision or deferred disposition for, an
offense that directly relates to the duties and responsibilities of
the administrator, employee, or representative, other than an
offense for which points are assigned under Section 708.052,
Transportation Code;
(2) has been convicted of or placed on deferred
adjudication community supervision or deferred disposition for an
offense, including:
(A) an offense listed in Sections 3g(a)(1)(A)
through (H), Article 42.12, Code of Criminal Procedure; or
(B) an offense, other than an offense described
by Subdivision (1), for which the person is subject to registration
under Chapter 62, Code of Criminal Procedure; or
(3) has been convicted of Medicare or Medicaid fraud,
has been excluded from participation in the state Medicaid program,
or has a hold on payment for reimbursement under the state Medicaid
program under Subchapter C, Chapter 531, Government Code.
(b) An emergency medical services provider that is directly
operated by a governmental entity is exempt from this section.
(e) Notwithstanding Chapter 773, Health and Safety Code, as
amended by this section, the Department of State Health Services
may not issue any new emergency medical services provider licenses
for the period beginning on September 1, 2013, and ending on August
31, 2014. The moratorium does not apply to the issuance of an
emergency medical services provider license to a municipality,
county, emergency services district, hospital, or emergency
medical services volunteer provider organization in this state, or
to an emergency medical services provider applicant who is applying
to provide services in response to 9-1-1 calls and is located in a
rural area, as that term is defined in Section 773.0045, Health and
Safety Code.
(f) Section 773.0571, Health and Safety Code, as amended by
this section, and Section 773.0573, Health and Safety Code, as
added by this section, apply only to an application for approval of
an emergency medical services provider license submitted to the
Department of State Health Services on or after the effective date
of this Act. An application submitted before the effective date of
this Act is governed by the law in effect immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
(g) The changes in law made by this section apply only to an
application for approval or renewal of an emergency medical
services provider license submitted to the Department of State
Health Services on or after the effective date of this Act. An
application submitted before the effective date of this Act is
governed by the law in effect immediately before the effective date
of this Act, and that law is continued in effect for that purpose.
SECTION 10. Section 32.0322, Human Resources Code, is
amended by amending Subsection (b) and adding Subsections (b-1),
(e), and (f) to read as follows:
(b) Subject to Subsections (b-1) and (e), the [The]
executive commissioner of the Health and Human Services Commission
by rule shall establish criteria for the department or the
commission's office of inspector general to suspend a provider's
billing privileges under the medical assistance program, revoke a
provider's enrollment under the program, or deny a person's
application to enroll as a provider under the program based on:
(1) the results of a criminal history check;
(2) any exclusion or debarment of the provider from
participation in a state or federally funded health care program;
(3) the provider's failure to bill for medical
assistance or refer clients for medical assistance within a
12-month period; or
(4) any of the provider screening or enrollment
provisions contained in 42 C.F.R. Part 455, Subpart E.
(b-1) In adopting rules under this section, the executive
commissioner of the Health and Human Services Commission shall
require revocation of a provider's enrollment or denial of a
person's application for enrollment as a provider under the medical
assistance program if the person has been excluded or debarred from
participation in a state or federally funded health care program as
a result of:
(1) a criminal conviction or finding of civil or
administrative liability for committing a fraudulent act, theft,
embezzlement, or other financial misconduct under a state or
federally funded health care program; or
(2) a criminal conviction for committing an act under
a state or federally funded health care program that caused bodily
injury to:
(A) a person who is 65 years of age or older;
(B) a person with a disability; or
(C) a person under 18 years of age.
(e) The department may reinstate a provider's enrollment
under the medical assistance program or grant a person's previously
denied application to enroll as a provider, including a person
described by Subsection (b-1), if the department finds:
(1) good cause to determine that it is in the best
interest of the medical assistance program; and
(2) the person has not committed an act that would
require revocation of a provider's enrollment or denial of a
person's application to enroll since the person's enrollment was
revoked or application was denied, as appropriate.
(f) The department must support a determination made under
Subsection (e) with written findings of good cause for the
determination.
SECTION 11. Section 32.073, Human Resources Code, is
amended by adding Subsection (c) to read as follows:
(c) Not later than the second anniversary of the date
national standards for electronic prior authorization of benefits
are adopted, the Health and Human Services Commission shall require
a health benefit plan issuer participating in the medical
assistance program or the agent of the health benefit plan issuer
that manages or administers prescription drug benefits to exchange
prior authorization requests electronically with a prescribing
provider participating in the medical assistance program who has
electronic prescribing capability and who initiates a request
electronically.
SECTION 12. Section 36.005, Human Resources Code, is
amended by amending Subsection (b-1) and adding Subsections (e),
(f), and (g) to read as follows:
(b-1) The period of ineligibility begins on the date on
which the judgment finding the provider liable under Section 36.052
is entered by the trial court [determination that the provider is
liable becomes final].
(e) Notwithstanding Subsection (b-1), the period of
ineligibility for an individual licensed by a health care
regulatory agency or a physician begins on the date on which the
determination that the individual or physician is liable becomes
final.
(f) For purposes of Subsection (e), a "physician" includes a
physician, a professional association composed solely of
physicians, a single legal entity authorized to practice medicine
owned by two or more physicians, a nonprofit health corporation
certified by the Texas Medical Board under Chapter 162, Occupations
Code, or a partnership composed solely of physicians.
(g) For purposes of Subsection (e), "health care regulatory
agency" has the meaning assigned by Section 774.001, Government
Code.
SECTION 13. (a) The Health and Human Services Commission,
in cooperation with the Department of State Health Services and the
Texas Medical Board, shall:
(1) as soon as practicable after the effective date of
this Act, conduct a thorough review of and solicit stakeholder
input regarding the laws and policies related to the use of
non-emergent services provided by ambulance providers under the
medical assistance program established under Chapter 32, Human
Resources Code;
(2) not later than January 1, 2014, make
recommendations to the legislature regarding suggested changes to
the law that would reduce the incidence of and opportunities for
fraud, waste, and abuse with respect to the activities described by
Subdivision (1) of this subsection; and
(3) amend the policies described by Subdivision (1) of
this subsection as necessary to assist in accomplishing the goals
described by Subdivision (2) of this subsection.
(b) This section expires September 1, 2015.
SECTION 14. (a) The Department of State Health Services,
in cooperation with the Health and Human Services Commission and
the Texas Medical Board, shall:
(1) as soon as practicable after the effective date of
this Act, conduct a thorough review of and solicit stakeholder
input regarding the laws and policies related to the licensure of
nonemergency transportation providers;
(2) not later than January 1, 2014, make
recommendations to the legislature regarding suggested changes to
the law that would reduce the incidence of and opportunities for
fraud, waste, and abuse with respect to the activities described by
Subdivision (1) of this subsection; and
(3) amend the policies described by Subdivision (1) of
this subsection as necessary to assist in accomplishing the goals
described by Subdivision (2) of this subsection.
(b) This section expires September 1, 2015.
SECTION 15. (a) The Texas Medical Board, in cooperation
with the Department of State Health Services and the Health and
Human Services Commission, shall:
(1) as soon as practicable after the effective date of
this Act, conduct a thorough review of and solicit stakeholder
input regarding the laws and policies related to:
(A) the delegation of health care services by
physicians or medical directors to qualified emergency medical
services personnel; and
(B) physicians' assessment of patients' needs for
purposes of ambulatory transfer or transport or other purposes;
(2) not later than January 1, 2014, make
recommendations to the legislature regarding suggested changes to
the law that would reduce the incidence of and opportunities for
fraud, waste, and abuse with respect to the activities described by
Subdivision (1) of this subsection; and
(3) amend the policies described by Subdivision (1) of
this subsection as necessary to assist in accomplishing the goals
described by Subdivision (2) of this subsection.
(b) This section expires September 1, 2015.
SECTION 16. (a) The Health and Human Services Commission
shall study the feasibility of developing and implementing a single
standard prior authorization form to be used for requesting prior
authorization for prescription drugs in the medical assistance
program by participating prescribers who do not have electronic
prescribing capability and are not able to initiate electronic
prior authorization requests. The commission shall complete the
study not later than December 31, 2014.
(b) If the Health and Human Services Commission determines
that developing and implementing the form described in Subsection
(a) of this section is feasible, will reduce administrative
burdens, and is cost-effective, the commission shall adjust
contracts with participating health benefit plan issuers and
participating health benefit plan administrators to require
acceptance of the form.
SECTION 17. (a) The office of inspector general of the
Health and Human Services Commission shall review the manner in
which:
(1) the office investigates fraud, waste, and abuse in
the supplemental nutrition assistance program under Chapter 33,
Human Resources Code, including in the provision of benefits under
that program; and
(2) the office coordinates with other state and
federal agencies in conducting those investigations.
(b) Not later than September 1, 2014, and based on the
review required by Subsection (a) of this section, the office of
inspector general of the Health and Human Services Commission shall
submit to the legislature a written report containing strategies
for addressing fraud, waste, and abuse in the supplemental
nutrition assistance program under Chapter 33, Human Resources
Code, including in the provision of benefits under that program.
(c) This section expires January 1, 2015.
SECTION 18. (a) This section is a clarification of
legislative intent regarding Subsection (s), Section 32.024, Human
Resources Code, and a validation of certain Health and Human
Services Commission acts and decisions.
(b) In 1999, the legislature became aware that certain
children enrolled in the Medicaid program were receiving treatment
under the program outside the presence of a parent or another
responsible adult. The treatment of unaccompanied children under
the Medicaid program resulted in the provision of unnecessary
services to those children, the exposure of those children to
unnecessary health and safety risks, and the submission of
fraudulent claims by Medicaid providers.
(c) In addition, in 1999, the legislature became aware of
allegations that certain Medicaid providers were offering money and
other gifts in exchange for a parent's or child's consent to receive
unnecessary services under the Medicaid program. In some cases, a
child was offered money or gifts in exchange for the parent's or
child's consent to have the child transported to a different
location to receive unnecessary services. In some of those cases,
once transported, the child received no treatment and was left
unsupervised for hours before being transported home. The
provision of money and other gifts by Medicaid providers in
exchange for parents' or children's consent to services deprived
those parents and children of the right to choose a Medicaid
provider without improper inducement.
(d) In response, in 1999, the legislature enacted Chapter
766 (H.B. 1285), Acts of the 76th Legislature, Regular Session,
1999, which amended Section 32.024, Human Resources Code, by
amending Subsection (s) and adding Subsection (s-1). As amended,
Subsection (s), Section 32.024, Human Resources Code, requires that
a child's parent or guardian or another adult authorized by the
child's parent or guardian accompany the child at a visit or
screening under the early and periodic screening, diagnosis, and
treatment program in order for a Medicaid provider to be reimbursed
for services provided at the visit or screening. As filed, the bill
required a child's parent or guardian to accompany the child. The
house committee report added the language allowing an adult
authorized by the child's parent or guardian to accompany the child
in order to accommodate a parent or guardian for whom accompanying
the parent's or guardian's child to each visit or screening would be
a hardship.
(e) The legislature finds that:
(1) in amending Subsection (s), Section 32.024, Human
Resources Code, in 1999, the legislature did not intend to:
(A) create a hardship for families whose
circumstances prevent a parent or guardian from accompanying the
parent's or guardian's child to each visit or screening under the
early and periodic screening, diagnosis, and treatment program; and
(B) compromise a child's access to medically
necessary services or to require a parent or guardian to jeopardize
his or her employment or the health and safety of other children in
the household;
(2) in enacting and enforcing administrative rules and
policies to implement the parental accompaniment requirement of
Subsection (s), Section 32.024, Human Resources Code, the Health
and Human Services Commission should give special consideration and
should reasonably accommodate the circumstances of a child who
lives in a single parent or guardian family and whose parent or
guardian:
(A) has a full-time job that does not allow the
parent or guardian to take time off during a provider's regular
business hours;
(B) attends school or participates in a job
training program that requires the parent's or guardian's full-time
attendance and does not allow absences for medical or personal
needs;
(C) is the caretaker of two or more children and
does not have access to child care;
(D) has a disability or illness that prevents the
parent or guardian from safely accompanying the child to a visit or
screening; or
(E) is the primary caregiver of a person who has a
disability or illness and for whom no alternate caregiver is
available; and
(3) in developing reasonable accommodations described
by this subsection, the Health and Human Services Commission should
not allow the provider of a service or an affiliate of the provider
to accompany the child as an authorized adult for purposes of
Paragraph (B), Subdivision (2), Subsection (s), Section 32.024,
Human Resources Code.
(f) The principal purposes of Chapter 766 (H.B. 1285), Acts
of the 76th Legislature, Regular Session, 1999, were to prevent
Medicaid providers from committing fraud, encourage parental
involvement in and management of health care of children enrolled
in the early and periodic screening, diagnosis, and treatment
program, and ensure the safety of children receiving services under
the Medicaid program. The addition of the language allowing an
adult authorized by a child's parent or guardian to accompany the
child furthered each of those purposes.
(g) The legislature, in amending Subsection (s), Section
32.024, Human Resources Code, understood that:
(1) the effectiveness of medical, dental, and therapy
services provided to a child improves when the child's parent or
guardian actively participates in the delivery of those services;
(2) a parent is responsible for the safety and
well-being of the parent's child, and that a parent cannot casually
delegate this responsibility to a stranger;
(3) a parent may not always be available to accompany
the parent's child at a visit to the child's doctor, dentist, or
therapist; and
(4) Medicaid providers and their employees and
associates have a financial interest in the delivery of services
under the Medicaid program and, accordingly, cannot fulfill the
responsibilities of a parent or guardian when providing services to
a child.
(h)(1) On March 15, 2012, the Health and Human Services
Commission notified certain Medicaid providers that state law and
commission policy require a child's parent or guardian or another
properly authorized adult to accompany a child receiving services
under the Medicaid program. This notice followed the commission's
discovery that some providers were transporting children from
schools to therapy clinics and other locations to receive therapy
services. Although the children were not accompanied by a parent or
guardian during these trips, the providers were obtaining
reimbursement for the trips under the Medicaid medical
transportation program. The commission clarified in the notice
that, in order for a provider to be reimbursed for transportation
services provided to a child under the Medicaid medical
transportation program, the child must be accompanied by the
child's parent or guardian or another adult who is not the provider
and whom the child's parent or guardian has authorized to accompany
the child by submitting signed, written consent to the provider.
(2) In May 2012, a lawsuit was filed to enjoin the
Health and Human Services Commission from enforcing Subsection (s),
Section 32.024, Human Resources Code, and 1 T.A.C. Section 380.207,
as interpreted in certain notices issued by the commission. A state
district court enjoined the commission from denying eligibility to
a child for transportation services under the Medicaid medical
transportation program if the child's parent or guardian does not
accompany the child, provided that the child's parent or guardian
authorizes any other adult to accompany the child. The court also
enjoined the commission from requiring as a condition for a
provider to be reimbursed for services provided to a child during a
visit or screening under the early and periodic screening,
diagnosis, and treatment program that the child be accompanied by
the child's parent or guardian, provided that the child's parent or
guardian authorizes another adult to accompany the child. The
state has filed a notice of appeal of the court's order.
(3) The legislature declares that a rule or policy
adopted by the Health and Human Services Commission before the
effective date of this Act to require that, in order for a Medicaid
provider to be reimbursed for services provided to a child under the
early and periodic screening, diagnosis, and treatment program or
the medical transportation program, the child must be accompanied
by the child's parent or guardian or another adult whom the child's
parent or guardian has authorized to accompany the child is
conclusively presumed, as of the date the rule or policy was
adopted, to be a valid exercise of the commission's authority and
consistent with the intent of the legislature, provided that the
rule or policy:
(A) was adopted pursuant to Subsection (s),
Section 32.024, Human Resources Code; and
(B) prohibits the child's parent or guardian from
authorizing the provider or the provider's employee or associate as
an adult who may accompany the child.
(4) Subdivision (3) of this subsection does not apply to:
(A) an action or decision that was void at the
time the action was taken or the decision was made;
(B) an action or decision that violates federal
law or the terms of a federal waiver; or
(C) an action or decision that, under a statute
of this state or the United States, was a misdemeanor or felony at
the time the action was taken or the decision was made.
(5) This section does not apply to:
(A) an action or decision that was void at the
time the action was taken or the decision was made;
(B) an action or decision that violates federal
law or the terms of a federal waiver; or
(C) an action or decision that, under a statute
of this state or the United States, was a misdemeanor or felony at
the time the action was taken or the decision was made.
SECTION 19. As soon as practicable after the effective date of
this Act, the executive commissioner of the Health and Human Services
Commission shall establish the data analysis unit required under Section
531.0082, Government Code, as added by this Act. The data analysis unit
shall provide the initial update required under Subsection (d), Section
531.0082, Government Code, as added by this Act, not later than the 30th
day after the last day of the first complete calendar quarter occurring
after the date the unit is established.
SECTION 20. 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 21. This Act takes effect September 1, 2013.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 8 passed the Senate on
April 15, 2013, by the following vote: Yeas 30, Nays 0, one
present not voting; May 22, 2013, Senate refused to concur in House
amendments and requested appointment of Conference Committee;
May 23, 2013, House granted request of the Senate; May 24, 2013,
Senate adopted Conference Committee Report by the following
vote: Yeas 27, Nays 4.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 8 passed the House, with
amendments, on May 20, 2013, by the following vote: Yeas 144,
Nays 0, two present not voting; May 23, 2013, House granted request
of the Senate for appointment of Conference Committee;
May 26, 2013, House adopted Conference Committee Report by the
following vote: Yeas 105, Nays 38, one present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor