Texas 2019 - 86th Regular

Texas House Bill HB4127 Compare Versions

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

Old	New	Differences
1	1	86R1044 LED-F
2	2	By: Hinojosa H.B. No. 4127
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the Healthy Texas Program; authorizing a fee.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Title 8, Insurance Code, is amended by adding
10	10	Subtitle N to read as follows:
11	11	SUBTITLE N. HEALTHY TEXAS PROGRAM
12	12	CHAPTER 1698. HEALTHY TEXAS PROGRAM
13	13	SUBCHAPTER A. GENERAL PROVISIONS
14	14	Sec. 1698.001. DEFINITIONS. In this chapter:
15	15	(1) "Affordable Care Act" means the Patient Protection
16	16	and Affordable Care Act (Pub. L. No. 111-148), as amended by the
17	17	Health Care and Education Reconciliation Act of 2010 (Pub. L.
18	18	No. 111-152).
19	19	(2) "Allied health practitioner":
20	20	(A) means a health care professional who:
21	21	(i) works to prevent disease transmission,
22	22	or diagnose, treat, or rehabilitate individuals; and
23	23	(ii) delivers direct patient care,
24	24	rehabilitation, treatment, diagnostics, and health improvement
25	25	interventions to restore and maintain optimal physical, sensory,
26	26	psychological, cognitive, and social functions; and
27	27	(B) includes technical and support staff,
28	28	audiologists, occupational therapists, social workers, and
29	29	radiographers.
30	30	(3) "Board" means the Healthy Texas Board established
31	31	under Section 1698.051.
32	32	(4) "Care coordination" means the services described
33	33	by Section 1698.152.
34	34	(5) "Care coordinator" means a person approved by the
35	35	board to provide care coordination.
36	36	(6) "Child health plan program" means the state
37	37	children's health insurance program established under Title XXI,
38	38	Social Security Act (42 U.S.C. Section 1397aa et seq.), or the
39	39	programs established under Chapters 62 and 63, Health and Safety
40	40	Code, as appropriate.
41	41	(7) "Essential community provider" means a person
42	42	acting as a safety net clinic, safety net health care provider, or
43	43	rural hospital.
44	44	(8) "Federally matched public health program" means:
45	45	(A) Medicaid; or
46	46	(B) the child health plan program.
47	47	(9) "Fund" means the healthy Texas fund established
48	48	under Section 1698.252.
49	49	(10) "Health benefit plan issuer" means an insurance
50	50	company or health maintenance organization regulated by the
51	51	department and authorized to issue a health insurance policy or
52	52	other health benefit plan. The term includes:
53	53	(A) a stock life, health, or accident insurance
54	54	company;
55	55	(B) a mutual life, health, or accident insurance
56	56	company;
57	57	(C) a stock casualty insurance company;
58	58	(D) a mutual casualty insurance company;
59	59	(E) a Lloyd's plan;
60	60	(F) a reciprocal or interinsurance exchange;
61	61	(G) a fraternal benefit society;
62	62	(H) a stipulated premium company;
63	63	(I) a nonprofit hospital, medical, or dental
64	64	service corporation, including a company subject to Chapter 842;
65	65	and
66	66	(J) a health maintenance organization.
67	67	(11) "Health care organization" means a
68	68	not-for-profit or public organization that is approved by the board
69	69	to provide health care services to members under the program.
70	70	(12) "Health care provider" means a person that is
71	71	licensed, certified, or otherwise authorized by the laws of this
72	72	state to provide or render health care in the ordinary course of
73	73	business or practice of a profession.
74	74	(13) "Health care providers' representative" means a
75	75	third party that is authorized by health care providers to
76	76	negotiate on their behalf with the program related to terms and
77	77	conditions affecting those health care providers.
78	78	(14) "Health care service" means any health care
79	79	service, including care coordination, that is included as a benefit
80	80	under the program.
81	81	(15) "Integrated health care delivery system" means a
82	82	provider organization that is:
83	83	(A) fully integrated operationally and
84	84	clinically to provide a broad range of health care services,
85	85	including preventive care, prenatal and well-baby care,
86	86	immunizations, screening diagnostics, emergency services, hospital
87	87	and medical services, surgical services, and ancillary services;
88	88	and
89	89	(B) compensated by the program using capitation
90	90	or facility budgets for the provision of health care services.
91	91	(16) "Long-term care services" has the meaning
92	92	assigned by Section 22.0011, Human Resources Code.
93	93	(17) "Medicaid" means the medical assistance program
94	94	established under Title XIX, Social Security Act (42 U.S.C. Section
95	95	1396 et seq.), or the medical assistance program established under
96	96	Chapter 32, Human Resources Code, as appropriate.
97	97	(18) "Medicare" means the Health Insurance for the
98	98	Aged Act under Title XVIII of the Social Security Act (42 U.S.C.
99	99	Section 1395 et seq.).
100	100	(19) "Member" means an individual who is enrolled in
101	101	the program.
102	102	(20) "Out-of-state health care service":
103	103	(A) means a health care service that:
104	104	(i) is provided in person to a member while
105	105	the member is physically located outside this state; and
106	106	(ii) is:
107	107	(a) medically necessary to be
108	108	provided while the member is physically outside this state; or
109	109	(b) clinically appropriate and
110	110	necessary and cannot be provided in this state because the health
111	111	care service can be provided only by a particular health care
112	112	provider physically located outside this state; and
113	113	(B) does not include a health care service
114	114	provided to a member by a health care provider qualified under
115	115	Section 1698.151 that is physically located outside this state.
116	116	(21) "Participating provider" means:
117	117	(A) a person that is a health care provider
118	118	qualified under Section 1698.151 that provides health care services
119	119	to members under the program; or
120	120	(B) a health care organization.
121	121	(22) "Prescription drug" has the meaning assigned by
122	122	Section 551.003, Occupations Code.
123	123	(23) "Program" means the Healthy Texas Program
124	124	established under this chapter.
125	125	(24) "Resident" means an individual whose primary
126	126	place of residence is located in this state without regard to the
127	127	individual's immigration status.
128	128	Sec. 1698.002. COVERAGE NOT EXCLUSIVE. This chapter does
129	129	not preempt a political subdivision from adopting additional health
130	130	care coverage that provides additional protections and benefits to
131	131	residents in the political subdivision's jurisdiction.
132	132	Sec. 1698.003. CONFLICT WITH OTHER LAW. (a) To the extent
133	133	any provision of state law is inconsistent with this chapter, this
134	134	chapter prevails, except as explicitly provided otherwise by this
135	135	chapter.
136	136	(b) This chapter may not be construed to alter in any way the
137	137	professional practice of health care providers or licensure
138	138	standards established under Title 3, Occupations Code.
139	139	SUBCHAPTER B. HEALTHY TEXAS BOARD
140	140	Sec. 1698.051. HEALTHY TEXAS BOARD. The Healthy Texas
141	141	Board is an agency of this state.
142	142	Sec. 1698.052. COMPOSITION OF BOARD. The board is composed
143	143	of the following nine members:
144	144	(1) four appointed by the governor;
145	145	(2) two appointed by the lieutenant governor;
146	146	(3) two appointed by the speaker of the house of
147	147	representatives; and
148	148	(4) the executive commissioner of the Health and Human
149	149	Services Commission, or the executive commissioner's designee, who
150	150	serves as a voting, ex officio member.
151	151	Sec. 1698.053. TERM; VACANCY. (a) Board members other than
152	152	an ex officio member shall be appointed for a term of two years.
153	153	(b) A vacancy must be filled for the unexpired term in the
154	154	same manner as the original appointment.
155	155	Sec. 1698.054. BOARD MEMBER QUALIFICATIONS. (a) Each
156	156	board member must:
157	157	(1) be a resident; and
158	158	(2) have demonstrated and acknowledged expertise in
159	159	health care.
160	160	(b) An individual may not be a board member unless the
161	161	individual is a member of the program. This subsection does not
162	162	apply to an ex officio member.
163	163	(c) Of the eight board members appointed by the governor,
164	164	lieutenant governor, and speaker of the house of representatives:
165	165	(1) at least one board member must represent a labor
166	166	organization representing registered nurses;
167	167	(2) at least one board member must represent the
168	168	general public;
169	169	(3) at least one board member must represent a labor
170	170	organization; and
171	171	(4) at least one board member must represent the
172	172	medical provider community.
173	173	(d) The governor, lieutenant governor, and speaker of the
174	174	house of representatives shall consider:
175	175	(1) the expertise of each board member and attempt to
176	176	make appointments so that the board's composition reflects a
177	177	diversity of expertise in the various aspects of health care; and
178	178	(2) the cultural, ethnic, and geographic diversity of
179	179	the state and attempt to make appointments so that the board's
180	180	composition reflects the communities of Texas.
181	181	(e) Each board member shall:
182	182	(1) meet the requirements of this chapter, the
183	183	Affordable Care Act, and all applicable state and federal laws and
184	184	regulations;
185	185	(2) serve the public interest of the individuals,
186	186	employers, and taxpayers seeking health care coverage through the
187	187	program; and
188	188	(3) ensure the operational well-being and fiscal
189	189	solvency of the program.
190	190	(f) A board member or employee of the board may not:
191	191	(1) be employed by, a consultant to, a member of the
192	192	board of directors of, affiliated with, or otherwise a
193	193	representative of a health care provider, a health care facility,
194	194	or a health clinic while serving on the board or as an employee of
195	195	the board;
196	196	(2) be a member, a board member, or an employee of a
197	197	trade association of health care facilities, health clinics, or
198	198	health care providers while serving on the board or as an employee
199	199	of the board; or
200	200	(3) be a health care provider unless the board member
201	201	or employee receives no compensation for rendering services as a
202	202	health care provider and does not have an ownership interest in a
203	203	health care practice.
204	204	Sec. 1698.055. BOARD MEMBER COMPENSATION. A board member
205	205	may not receive compensation but is entitled to reimbursement of
206	206	the travel expenses incurred by the board member while conducting
207	207	the business of the board, as provided in the General
208	208	Appropriations Act.
209	209	Sec. 1698.056. CONFLICT OF INTEREST. (a) A board member
210	210	may not make, participate in making, or in any way attempt to make
211	211	use of the board member's official position to influence the making
212	212	of a decision the board member knows or has reason to know will have
213	213	a material financial effect, distinguishable from its effect on the
214	214	public generally, on:
215	215	(1) the board member or a member of the board member's
216	216	immediate family;
217	217	(2) a person or entity that was the source of a benefit
218	218	or benefits aggregating $250 or more in value received by or
219	219	promised to the board member within 12 months before the date the
220	220	decision is made; or
221	221	(3) a business entity in which the board member is a
222	222	director, officer, partner, trustee, or employee, or holds any
223	223	position of management.
224	224	(b) For purposes of Subsection (a), "benefit" has the
225	225	meaning assigned by Section 36.01, Penal Code, but does not
226	226	include:
227	227	(1) a gift; or
228	228	(2) a loan by a commercial lending institution in the
229	229	regular course of business on terms available to the public.
230	230	Sec. 1698.057. IMMUNITY. The following persons are not
231	231	liable, and a cause of action does not arise against any of the
232	232	following persons, for a good faith act or omission in exercising
233	233	powers and performing duties under this chapter:
234	234	(1) the board;
235	235	(2) a board member; or
236	236	(3) an officer or employee of the board.
237	237	Sec. 1698.058. BOARD ELECTION. The board annually shall
238	238	elect a chairperson.
239	239	Sec. 1698.059. EXECUTIVE DIRECTOR. The board shall hire an
240	240	executive director to organize, administer, and manage the program
241	241	and the operations of the board. The executive director serves at
242	242	the pleasure of the board.
243	243	Sec. 1698.060. OPEN MEETINGS; OPEN RECORDS. The board is
244	244	subject to Chapters 551 and 552, Government Code. The board may
245	245	conduct a closed meeting to deliberate:
246	246	(1) business and financial issues relating to a
247	247	contract being negotiated; or
248	248	(2) rates to be paid under the program.
249	249	Sec. 1698.061. RULES. (a) The board may adopt rules
250	250	necessary to implement and enforce this chapter.
251	251	(b) The board by rule shall set fees in amounts reasonable
252	252	and necessary to implement this chapter.
253	253	(c) The board by rule shall establish dispute resolution
254	254	procedures to address member disputes. Dispute resolution
255	255	procedures must:
256	256	(1) include a patient advocate to assist members in
257	257	the dispute resolution process; and
258	258	(2) provide for a member to withdraw from the program.
259	259	(d) The board may adopt narrowly focused rules relating
260	260	solely to health care organizations for the specific purpose of
261	261	ensuring consistent compliance with this chapter.
262	262	Sec. 1698.062. ADVISORY COMMITTEE. (a) The executive
263	263	commissioner of the Health and Human Services Commission shall
264	264	establish an advisory committee to advise the board on all policy
265	265	matters for the program.
266	266	(b) The advisory committee is composed of 22 members
267	267	appointed by the governor, lieutenant governor, or speaker of the
268	268	house of representatives as follows:
269	269	(1) the governor shall appoint:
270	270	(A) one board-certified physician;
271	271	(B) one dentist;
272	272	(C) one representative of private hospitals;
273	273	(D) one representative of public hospitals;
274	274	(E) one representative of an integrated health
275	275	care delivery system;
276	276	(F) two consumers of health care, one of whom is a
277	277	person with a disability; and
278	278	(G) one representative of a business that employs
279	279	fewer than 25 people;
280	280	(2) the lieutenant governor shall appoint:
281	281	(A) one board-certified physician;
282	282	(B) two registered nurses;
283	283	(C) one mental health care provider;
284	284	(D) one consumer of health care who is at least 65
285	285	years of age;
286	286	(E) one representative of essential community
287	287	providers; and
288	288	(F) one member of organized labor; and
289	289	(3) the speaker of the house shall appoint:
290	290	(A) two board-certified physicians, both of whom
291	291	must be primary care providers;
292	292	(B) one allied health practitioner who holds a
293	293	license to practice a health care profession;
294	294	(C) one pharmacist;
295	295	(D) one consumer of health care;
296	296	(E) one representative of organized labor; and
297	297	(F) one representative of a business that employs
298	298	more than 250 people.
299	299	(c) Of the board-certified physicians appointed under
300	300	Subsections (b)(1)(A), (b)(2)(A), and (b)(3)(A), at least one must
301	301	be a psychiatrist.
302	302	(d) In making appointments under this section, the
303	303	governor, lieutenant governor, and speaker of the house of
304	304	representatives shall attempt to reflect the geographic and
305	305	economic diversity of the state. Appointments to the committee
306	306	shall be made without regard to the race, color, sex, religion, age,
307	307	or national origin of the appointees.
308	308	(e) A committee member serves a four-year term and may be
309	309	reappointed.
310	310	(f) The executive commissioner of the Health and Human
311	311	Services Commission shall notify the appropriate appointing
312	312	authority of any expected vacancies on the advisory committee. If a
313	313	vacancy occurs on the committee, the appropriate appointing
314	314	authority shall appoint a successor, in the same manner as the
315	315	original appointment, to serve for the remainder of the unexpired
316	316	term. The appropriate appointing authority shall appoint the
317	317	successor not later than the 30th day after the date the vacancy
318	318	occurs.
319	319	(g) A committee member:
320	320	(1) may not receive compensation for serving on the
321	321	committee;
322	322	(2) is entitled to reimbursement for travel expenses
323	323	incurred by the committee member while conducting the business of
324	324	the committee; and
325	325	(3) is entitled to the per diem provided by the General
326	326	Appropriations Act for attending meetings of the committee.
327	327	(h) The advisory committee shall meet at least six times per
328	328	year in a place convenient to the public.
329	329	(i) The advisory committee is subject to Chapters 551 and
330	330	552, Government Code.
331	331	(j) The advisory committee shall elect a chairperson who
332	332	shall serve for two years and may be reelected for an additional two
333	333	years.
334	334	(k) To be eligible for appointment to the advisory
335	335	committee, an individual must have worked in the field the
336	336	individual represents on the committee for a period of at least two
337	337	years before being appointed to the committee.
338	338	(l) An advisory committee member or individual working with
339	339	or for a committee member may not use for personal benefit any
340	340	information that is filed with or obtained by the committee and that
341	341	is not generally available to the public.
342	342	(m) The board shall provide administrative support,
343	343	including staff, for the advisory committee.
344	344	(n) The advisory committee is not subject to Chapter 2110,
345	345	Government Code.
346	346	Sec. 1698.063. POWERS AND DUTIES OF BOARD; HEALTHY TEXAS
347	347	PROGRAM. (a) The board has all the powers and duties necessary to
348	348	establish and implement the program.
349	349	(b) The board shall, to the extent possible, organize,
350	350	administer, and market the program and services as a comprehensive
351	351	universal single-payer program under the name "Healthy Texas
352	352	Program" or any other name the board adopts. The program shall be
353	353	administered regardless of the law or source in which the
354	354	definition of a benefit is found, including, subject to the
355	355	election of the retiree, retiree health benefits.
356	356	(c) In implementing this chapter, the board shall avoid
357	357	jeopardizing federal financial participation in the federally
358	358	supported programs that are incorporated into the program.
359	359	(d) The board shall promote public understanding and
360	360	awareness of available benefits and programs.
361	361	(e) The board may consider any matter necessary to implement
362	362	this chapter and the purposes of this chapter. The board does not
363	363	have any executive, administrative, or appointive duties except as
364	364	provided by this chapter or other law.
365	365	(f) The board shall employ necessary staff and authorize
366	366	reasonable expenditures, as necessary, from the fund to pay program
367	367	expenses and to administer the program.
368	368	(g) The board may:
369	369	(1) sue and be sued;
370	370	(2) receive and accept gifts, grants, or donations of
371	371	money from any agency of the federal government, any agency of this
372	372	state, or any municipality, county, or other political subdivision
373	373	of this state;
374	374	(3) receive and accept gifts, grants, or donations
375	375	from individuals, associations, private foundations, or
376	376	corporations, in compliance with the conflict-of-interest
377	377	provisions adopted by board rule; and
378	378	(4) share information with relevant state
379	379	governmental entities, in a manner that is consistent with the
380	380	confidentiality provisions in this chapter, necessary for
381	381	administering the program.
382	382	Sec. 1698.064. CONTRACTS. (a) The board may enter into any
383	383	necessary contracts, including contracts with health care
384	384	providers, integrated health care delivery systems, and care
385	385	coordinators.
386	386	(b) The board may contract with a not-for-profit
387	387	organization to provide assistance to:
388	388	(1) consumers with respect to selecting a care
389	389	coordinator or health care organization, enrolling to obtain
390	390	services available through the program, obtaining health care
391	391	services, withdrawing from the program or from an aspect of the
392	392	program, and other matters relating to the program; or
393	393	(2) health care providers providing, seeking, or
394	394	considering whether to provide health care services under the
395	395	program with respect to participating in a health care organization
396	396	and interacting with a health care organization.
397	397	Sec. 1698.065. DATA TRANSPARENCY. (a) To promote
398	398	transparency, assess adherence to patient care standards, compare
399	399	patient outcomes, and review use of health care services paid for by
400	400	the program, the board shall provide for the collection and
401	401	availability of:
402	402	(1) inpatient discharge data, including acuity and
403	403	risk of mortality;
404	404	(2) emergency department and ambulatory surgery data,
405	405	including charge data, length of stay, and patients' unit of
406	406	observation; and
407	407	(3) hospital annual financial data, including:
408	408	(A) community benefits by hospital in dollar
409	409	value;
410	410	(B) number and classification of employees by
411	411	hospital unit;
412	412	(C) number of hours worked by hospital unit;
413	413	(D) employee wage information by job title and
414	414	hospital unit;
415	415	(E) number of registered nurses per staffed bed
416	416	by hospital unit;
417	417	(F) type and value of health information
418	418	technology; and
419	419	(G) annual spending on health information
420	420	technology, including purchases, upgrades, and maintenance.
421	421	(b) The board shall make all disclosed data collected under
422	422	Subsection (a) publicly available and searchable on an Internet
423	423	website established and maintained by the Department of State
424	424	Health Services.
425	425	(c) The board shall, directly and through grants to
426	426	not-for-profit entities, conduct programs using data collected
427	427	through the program to promote and protect public, environmental,
428	428	and occupational health, including cooperation with other data
429	429	collection and research programs of the Department of State Health
430	430	Services and the Health and Human Services Commission, consistent
431	431	with this chapter and other applicable law.
432	432	Sec. 1698.066. DISCLOSURE OF PERSONALLY IDENTIFIABLE
433	433	INFORMATION. (a) Notwithstanding any other law, the board, the
434	434	program, a state or local agency, or a public employee acting under
435	435	color of law may not provide or disclose to anyone, including the
436	436	federal government, any personally identifiable information
437	437	obtained under this chapter, including an individual's religious
438	438	beliefs, practices, or affiliation, national origin, ethnicity, or
439	439	immigration status for law enforcement or immigration purposes.
440	440	(b) Notwithstanding any other law, a law enforcement agency
441	441	may not use the money, facilities, property, equipment, or
442	442	personnel of the board or the program to investigate, enforce, or
443	443	assist in the investigation or enforcement of any criminal, civil,
444	444	or administrative violation or warrant for a violation of any
445	445	requirement that individuals register with the federal government
446	446	or any federal agency based on religion, national origin,
447	447	ethnicity, or immigration status.
448	448	SUBCHAPTER C. ELIGIBILITY AND ENROLLMENT
449	449	Sec. 1698.101. ELIGIBILITY AND ENROLLMENT. (a) Every
450	450	resident is eligible and entitled to enroll as a member under the
451	451	program.
452	452	(b) A member may not be required to pay:
453	453	(1) any fee, payment, or other charge for enrolling in
454	454	or being a member under the program; or
455	455	(2) any premium, co-payment, coinsurance, deductible,
456	456	or any other form of cost sharing for all covered benefits.
457	457	(c) A college, university, or other institution of higher
458	458	education in this state may purchase coverage under the program for
459	459	a student, or a student's dependent, who is not a resident.
460	460	SUBCHAPTER D. BENEFITS
461	461	Sec. 1698.121. BENEFITS. (a) Covered health care benefits
462	462	under the program include all medical care determined to be
463	463	medically appropriate by a member's health care provider.
464	464	(b) Covered health care benefits for a member include:
465	465	(1) inpatient and outpatient medical and health
466	466	facility services;
467	467	(2) inpatient and outpatient professional health care
468	468	provider medical services;
469	469	(3) diagnostic imaging, laboratory services, and
470	470	other diagnostic and evaluative services;
471	471	(4) medical equipment, appliances, and assistive
472	472	technology, including prosthetics, eyeglasses, and hearing aids
473	473	and the repair, technical support, and customization needed for
474	474	individual use;
475	475	(5) inpatient and outpatient rehabilitative care;
476	476	(6) emergency care services;
477	477	(7) emergency transportation;
478	478	(8) necessary transportation for health care services
479	479	for an individual with a disability or who may qualify as low
480	480	income;
481	481	(9) child and adult immunizations and preventive care;
482	482	(10) health and wellness education;
483	483	(11) hospice care;
484	484	(12) care in a skilled nursing facility;
485	485	(13) home health care, including health care provided
486	486	in an assisted living facility;
487	487	(14) mental health services;
488	488	(15) substance abuse treatment;
489	489	(16) dental care;
490	490	(17) vision care;
491	491	(18) prescription drugs;
492	492	(19) pediatric care;
493	493	(20) prenatal and postnatal care;
494	494	(21) podiatric care;
495	495	(22) chiropractic care;
496	496	(23) acupuncture;
497	497	(24) therapies that are shown by the National
498	498	Institutes of Health, National Center for Complementary and
499	499	Integrative Health to be safe and effective;
500	500	(25) blood and blood products;
501	501	(26) dialysis;
502	502	(27) adult day care;
503	503	(28) rehabilitative and habilitative services;
504	504	(29) ancillary health care or social services covered
505	505	by a local health care system before the effective date of the
506	506	program;
507	507	(30) ancillary health care or social services covered
508	508	by a community center for persons with developmental disabilities
509	509	under Chapter 534, Health and Safety Code, before the effective
510	510	date of the program;
511	511	(31) case management and care coordination;
512	512	(32) language interpretation and translation for
513	513	health care services, including sign language, Braille, or other
514	514	services needed for individuals with communication barriers; and
515	515	(33) health care and long-term supportive services
516	516	covered under Medicaid or the child health plan program before the
517	517	effective date of the program.
518	518	(c) Covered health care benefits for a member also include
519	519	all health care services required to be covered under any of the
520	520	following programs or by the following providers, without regard to
521	521	whether the member would otherwise be eligible for or covered by the
522	522	program or source listed:
523	523	(1) the child health plan program;
524	524	(2) Medicaid;
525	525	(3) Medicare;
526	526	(4) a health benefit plan issuer under this code;
527	527	(5) any additional health care service authorized to
528	528	be added to the program's benefits by the board; and
529	529	(6) all essential health benefits mandated by the
530	530	Affordable Care Act.
531	531	Sec. 1698.122. BENEFITS OFFERED BY A HEALTH BENEFIT PLAN
532	532	ISSUER. (a) Except as provided by Subsection (b), a health benefit
533	533	plan issuer may not offer benefits or cover any services for which
534	534	coverage is offered to individuals under the program but may, if
535	535	otherwise authorized, offer benefits to cover health care services
536	536	that are not offered to individuals under the program.
537	537	(b) This chapter does not prohibit a health benefit plan
538	538	issuer from offering benefits to or for individuals, including
539	539	their families, who are employed or self-employed in this state but
540	540	who are not residents.
541	541	SUBCHAPTER E. DELIVERY OF CARE
542	542	Sec. 1698.151. HEALTH CARE PROVIDERS. (a) A health care
543	543	provider may participate in the program to perform services in this
544	544	state.
545	545	(b) The board shall establish and maintain procedures and
546	546	standards for recognizing health care providers physically located
547	547	outside this state to provide coverage under the program for
548	548	members who require out-of-state health care services while
549	549	temporarily located outside this state.
550	550	(c) A participating provider may provide covered health
551	551	care services under the program that the provider is authorized to
552	552	perform for the member under the applicable circumstances.
553	553	(d) A member may choose to receive health care services
554	554	under the program from any participating provider, consistent with:
555	555	(1) this chapter;
556	556	(2) the willingness or availability of the provider,
557	557	subject to provisions of this chapter relating to discrimination;
558	558	and
559	559	(3) the applicable clinically relevant circumstances.
560	560	(e) Subject to Subsection (f), a member who chooses to
561	561	enroll with an integrated health care delivery system, group
562	562	medical practice, or essential community provider that offers
563	563	comprehensive services must retain membership with the system,
564	564	practice, or provider until the first anniversary of the date an
565	565	initial 90-day evaluation period expires. The member may withdraw
566	566	from the system, practice, or provider for any reason during the
567	567	evaluation period. The initial 90-day evaluation period commences
568	568	on the date the member first sees a primary care provider.
569	569	(f) A member who wants to withdraw after the initial 90-day
570	570	evaluation period must request a withdrawal under the dispute
571	571	resolution procedures established by the board and may request
572	572	assistance from the patient advocate in resolving the dispute. The
573	573	dispute must be resolved in a timely manner and may not have an
574	574	adverse effect on the care the member receives.
575	575	Sec. 1698.152. CARE COORDINATION. (a) A member's care
576	576	coordinator shall provide care coordination to the member. A care
577	577	coordinator may employ or use the services of other individuals or
578	578	entities to assist in providing care coordination for the member
579	579	consistent with board rules, statutory requirements, and
580	580	applicable occupational regulations.
581	581	(b) Care coordination includes administrative tracking and
582	582	medical recordkeeping services for members, except as otherwise
583	583	specified for integrated health care delivery systems.
584	584	(c) Care coordination administrative tracking and medical
585	585	recordkeeping services for members may not be required to use a
586	586	certified electronic health record, meet any other requirements of
587	587	the Health Information Technology for Economic and Clinical Health
588	588	Act, enacted under the American Recovery and Reinvestment Act of
589	589	2009 (Pub. L. No. 111-5), or meet certification requirements of the
590	590	Centers for Medicare and Medicaid Services' electronic health
591	591	record incentive programs, including meaningful use requirements.
592	592	(d) A referral from a care coordinator is not required for a
593	593	member to see an eligible provider.
594	594	Sec. 1698.153. CARE COORDINATORS. (a) A care coordinator
595	595	shall comply with all federal and state privacy laws, including:
596	596	(1) the Health Insurance Portability and
597	597	Accountability Act of 1996 (Pub. L. No. 104-191) and regulations
598	598	adopted under that Act;
599	599	(2) state law relating to the confidentiality of
600	600	medical information, including Chapter 181, Health and Safety Code;
601	601	(3) Subtitle D, Title 5; and
602	602	(4) Title 11, Business & Commerce Code.
603	603	(b) A care coordinator may be an individual or entity
604	604	approved by the program that is:
605	605	(1) a health care practitioner who is:
606	606	(A) the member's primary care provider;
607	607	(B) the member's provider of primary
608	608	gynecological care; or
609	609	(C) at the option of a member who has a chronic
610	610	condition that requires specialty care, a specialist health care
611	611	practitioner who regularly and continually provides treatment to
612	612	the member for that condition;
613	613	(2) an entity that is:
614	614	(A) a health facility;
615	615	(B) a health maintenance organization;
616	616	(C) a nursing facility or assisted living
617	617	facility under Chapter 242 or 247, Health and Safety Code, or a
618	618	program for long-term care services coverage developed by the
619	619	board;
620	620	(D) a county medical facility;
621	621	(E) a residential care facility for individuals
622	622	with chronic, life-threatening illness;
623	623	(F) an Alzheimer's day care resource center;
624	624	(G) a residential care facility for the elderly;
625	625	(H) a home health agency;
626	626	(I) a private duty nursing agency;
627	627	(J) a hospice;
628	628	(K) a pediatric day health and respite care
629	629	facility;
630	630	(L) a home care service; or
631	631	(M) a mental health care provider;
632	632	(3) a health care organization;
633	633	(4) a jointly managed trust authorized under 29 U.S.C.
634	634	Section 141 et seq. that contains a plan of benefits for employees
635	635	that is negotiated in a collective bargaining agreement governing
636	636	wages, hours, and working conditions of the employer that is
637	637	authorized under 29 U.S.C. Section 157; or
638	638	(5) a not-for-profit or governmental entity approved
639	639	by the program.
640	640	(c) Subsection (b)(4) does not preclude a trust described by
641	641	Subsection (b)(4) from becoming a care coordinator under Subsection
642	642	(b)(5) or a health care organization under Section 1698.158.
643	643	(d) To maintain approval as a care coordinator under the
644	644	program, a care coordinator must:
645	645	(1) renew its license every three years as prescribed
646	646	by board rule; and
647	647	(2) provide to the program any data required by the
648	648	Department of State Health Services under Chapter 108, Health and
649	649	Safety Code, that would enable the board to evaluate the impact of
650	650	care coordinators on quality, outcomes, and cost of health care.
651	651	(e) An individual or entity may not be a care coordinator
652	652	unless the services included in care coordination are within the
653	653	individual's professional scope of practice or the entity's legal
654	654	authority.
655	655	Sec. 1698.154. ENROLLMENT WITH CARE COORDINATOR. (a)
656	656	Before receiving health care services to be paid for under the
657	657	program, a member must be encouraged to enroll with a care
658	658	coordinator that agrees to provide care coordination. If a member
659	659	receives health care services before choosing a care coordinator,
660	660	the program shall assist the member, when appropriate, with
661	661	choosing a care coordinator. The member must remain enrolled with
662	662	that care coordinator until the member becomes enrolled with a
663	663	different care coordinator or ceases to be a member. A member may
664	664	change care coordinators on terms at least as permissive as those
665	665	under Medicaid relating to an individual changing primary care
666	666	providers or managed care organizations.
667	667	(b) A health care provider may be reimbursed for services
668	668	only if the member is enrolled with a care coordinator at the time
669	669	the health care service is provided.
670	670	(c) A health care organization may establish rules relating
671	671	to care coordination for its members that are different from this
672	672	subchapter but otherwise consistent with this chapter and other
673	673	applicable laws.
674	674	Sec. 1698.155. PROCEDURES AND STANDARDS FOR CARE
675	675	COORDINATION. (a) The board by rule shall develop and implement
676	676	procedures and standards for an individual or entity to be approved
677	677	as a care coordinator in the program, including procedures and
678	678	standards relating to the revocation, suspension, limitation, or
679	679	annulment of approval on a determination that the individual or
680	680	entity:
681	681	(1) is incompetent to be a care coordinator;
682	682	(2) has exhibited a course of conduct that is
683	683	inconsistent with program standards and rules;
684	684	(3) exhibits an unwillingness to comply with program
685	685	standards and rules; or
686	686	(4) is a potential threat to the public health or
687	687	safety.
688	688	(b) The procedures and standards adopted by the board must
689	689	be consistent with professional practice, licensure standards, and
690	690	rules established under the Government Code, Health and Safety
691	691	Code, Human Resources Code, Insurance Code, and Occupations Code,
692	692	as applicable.
693	693	(c) In developing and implementing standards of approval of
694	694	care coordinators for individuals receiving chronic mental health
695	695	care services, the board shall consult with the Health and Human
696	696	Services Commission.
697	697	Sec. 1698.156. OCCUPATIONAL LAWS NOT AFFECTED. Nothing in
698	698	Section 1698.152, 1698.153, 1698.154, or 1698.155 authorizes an
699	699	individual to engage in any act in violation of Title 3, Occupations
700	700	Code.
701	701	Sec. 1698.157. PAYMENT FOR HEALTH CARE SERVICES AND CARE
702	702	COORDINATION. (a) The board shall adopt rules related to
703	703	contracting and establishing payment methodologies for covered
704	704	health care services and care coordination provided to members
705	705	under the program by participating providers, care coordinators,
706	706	and health care organizations. A variety of different payment
707	707	methodologies may be used, including those established on a
708	708	demonstration basis. All payment rates under the program shall be
709	709	reasonable and reasonably related to the cost of efficiently
710	710	providing the health care service and ensuring an adequate and
711	711	accessible supply of health care services.
712	712	(b) Health care services provided to a member under the
713	713	program, except for care coordination, must be paid for on a
714	714	fee-for-service basis unless the board establishes another payment
715	715	methodology.
716	716	(c) Notwithstanding Subsection (b), integrated health care
717	717	delivery systems, essential community providers, and group medical
718	718	practices that provide comprehensive, coordinated services may
719	719	choose to be reimbursed on the basis of a capitated system operating
720	720	budget or a non-capitated system operating budget that covers all
721	721	costs of providing health care services.
722	722	(d) The program shall engage in good faith negotiations with
723	723	health care providers' representatives under Subchapter H,
724	724	including in relation to rates of payment for health care services,
725	725	rates of payment for prescription and nonprescription drugs, and
726	726	payment methodologies. Those negotiations shall be through a single
727	727	entity on behalf of the entire program for prescription and
728	728	nonprescription drugs.
729	729	(e) Payment for health care services established under this
730	730	chapter is considered payment in full. A participating provider may
731	731	not charge a rate in excess of the payment established under this
732	732	chapter for any health care service provided to a member under the
733	733	program and may not solicit or accept payment from any member or
734	734	third party for any health care service, except as provided under a
735	735	federal program. This section does not preclude the program from
736	736	acting as a primary or secondary payer in conjunction with another
737	737	third-party payer when permitted by a federal program.
738	738	(f) The board by rule may adopt payment methodologies for
739	739	the payment of capital-related expenses for specifically
740	740	identified capital expenditures incurred by not-for-profit or
741	741	governmental entities that are health facilities under Subtitle B,
742	742	Title 4, Health and Safety Code. Any capital-related expense
743	743	generated by a capital expenditure that requires prior approval
744	744	must have received that approval before being paid by the program.
745	745	The approval must be based on achievement of the program standards
746	746	described by Subchapter F.
747	747	(g) Payment methodologies and payment rates must include a
748	748	distinct component of reimbursement for direct and indirect
749	749	graduate medical education.
750	750	(h) The board by rule shall adopt payment methodologies and
751	751	procedures for paying for health care services provided to a member
752	752	while the member is located outside this state.
753	753	Sec. 1698.158. HEALTH CARE ORGANIZATIONS. (a) A member may
754	754	choose to enroll with and receive program care coordination and
755	755	ancillary health care services from a health care organization.
756	756	(b) The health care organization must be a not-for-profit or
757	757	governmental entity that is approved by the board and is:
758	758	(1) a local health care system; or
759	759	(2) a community center for persons with developmental
760	760	disabilities under Chapter 534, Health and Safety Code.
761	761	(c) To maintain approval under the program, a health care
762	762	organization must:
763	763	(1) renew the approval as frequently as prescribed by
764	764	board rule; and
765	765	(2) provide to the program any data required by the
766	766	Department of State Health Services under Chapter 108, Health and
767	767	Safety Code, that would enable the board to evaluate the impact of
768	768	health care organizations on quality outcomes, and cost of health
769	769	care.
770	770	Sec. 1698.159. PROCEDURES AND STANDARDS FOR HEALTH CARE
771	771	ORGANIZATIONS. (a) The board by rule shall develop and implement
772	772	procedures and standards for an entity to be approved as a health
773	773	care organization in the program, including procedures and
774	774	standards relating to the revocation, suspension, limitation, or
775	775	annulment of approval on a determination that the entity:
776	776	(1) is incompetent to be a health care organization;
777	777	(2) has exhibited a course of conduct that is
778	778	inconsistent with program standards and rules;
779	779	(3) exhibits an unwillingness to comply with program
780	780	standards and rules; or
781	781	(4) is a potential threat to the public health or
782	782	safety.
783	783	(b) The procedures and standards adopted by the board must
784	784	be consistent with professional practice, licensure standards, and
785	785	rules established under the Government Code, Health and Safety
786	786	Code, Human Resources Code, Insurance Code, and Occupations Code,
787	787	as applicable.
788	788	(c) In developing and implementing standards of approval of
789	789	health care organizations, the board shall consult with the Health
790	790	and Human Services Commission.
791	791	Sec. 1698.160. BEST INTEREST OF THE PATIENT. A health care
792	792	organization may not use health information technology or clinical
793	793	practice guidelines that limit the effective exercise of the
794	794	professional judgment of physicians and registered nurses.
795	795	Physicians and registered nurses shall be free to override health
796	796	information technology and clinical practice guidelines if, in
797	797	their professional judgment, it is in the best interest of the
798	798	patient and consistent with the patient's wishes.
799	799	SUBCHAPTER F. PROGRAM STANDARDS
800	800	Sec. 1698.201. PROGRAM STANDARDS. (a) The board by rule
801	801	shall establish requirements and standards for the program and for
802	802	health care organizations, care coordinators, and health care
803	803	providers, consistent with this chapter and applicable
804	804	professional practice, licensure standards, and rules of health
805	805	care providers and health care professionals established under the
806	806	Government Code, Health and Safety Code, Human Resources Code,
807	807	Insurance Code, and Occupations Code, including requirements and
808	808	standards related to:
809	809	(1) the scope, quality, and accessibility of health
810	810	care services;
811	811	(2) relations between health care organizations or
812	812	health care providers and members; and
813	813	(3) relations between health care organizations and
814	814	health care providers, including credentialing and participation
815	815	in the health care organization, and terms, methods, and rates of
816	816	payment.
817	817	(b) The board by rule shall establish requirements and
818	818	standards under the program that include provisions to promote:
819	819	(1) simplification, transparency, uniformity, and
820	820	fairness in health care provider credentialing and participation in
821	821	health care organization networks, referrals, payment procedures
822	822	and rates, claims processing, and approval of health care services,
823	823	as applicable;
824	824	(2) in-person primary and preventive care, care
825	825	coordination, efficient and effective health care services,
826	826	quality assurance, and promotion of public, environmental, and
827	827	occupational health;
828	828	(3) elimination of health care disparities;
829	829	(4) nondiscrimination with respect to members and
830	830	health care providers on the basis of race, color, ancestry,
831	831	national origin, religion, citizenship, immigration status,
832	832	primary language, mental or physical disability, age, sex, gender,
833	833	sexual orientation, gender identity or expression, medical
834	834	condition, genetic information, marital status, familial status,
835	835	military or veteran status, or source of income;
836	836	(5) accessibility of care coordination, health care
837	837	organization services, and health care services, including
838	838	accessibility for people with disabilities and people with limited
839	839	ability to speak or understand English; and
840	840	(6) the provision of care coordination, health care
841	841	organization services, and health care services in a culturally
842	842	competent manner.
843	843	(c) Notwithstanding Subsection (b)(4), health care services
844	844	provided under the program must be appropriate to the member's
845	845	clinically relevant circumstances.
846	846	(d) The board by rule shall establish requirements and
847	847	standards, to the extent authorized by federal law, for replacing
848	848	and merging with the program health care services and ancillary
849	849	services currently provided by other programs, including:
850	850	(1) Medicare;
851	851	(2) the Affordable Care Act; and
852	852	(3) other federally matched public health programs.
853	853	Sec. 1698.202. EQUAL REQUIREMENTS AND STANDARDS. Any
854	854	participating provider or care coordinator that is organized as a
855	855	for-profit entity shall meet the same requirements and standards as
856	856	entities organized as not-for-profit entities, and payments under
857	857	the program paid to for-profit entities may not be calculated to
858	858	accommodate the generation of profit, revenue for dividends, or
859	859	other return on investment or the payment of taxes that would not be
860	860	paid by a not-for-profit entity.
861	861	Sec. 1698.203. INFORMATION REQUIRED. Each participating
862	862	provider shall furnish information as required by the Department of
863	863	State Health Services under Chapter 108, Health and Safety Code,
864	864	and permit examination of that information by the program as may be
865	865	reasonably required for purposes of reviewing accessibility and use
866	866	of health care services, quality assurance, cost containment, the
867	867	making of payments, and statistical or other studies of the
868	868	operation of the program or for protection and promotion of public,
869	869	environmental, and occupational health.
870	870	Sec. 1698.204. CONSULTATION ON POLICY DETERMINATIONS. In
871	871	developing requirements and standards and making other policy
872	872	determinations under this subchapter, the board shall consult with
873	873	representatives of members, health care providers, care
874	874	coordinators, health care organizations, labor organizations
875	875	representing health care employees, and other interested parties.
876	876	SUBCHAPTER G. FUNDING
877	877	Sec. 1698.251. FEDERAL HEALTH PROGRAMS AND FUNDING. (a)
878	878	The board shall seek any federal waiver or other federal approval
879	879	and arrangement and submit each state plan amendment necessary to
880	880	operate the program.
881	881	(b) The board shall apply to the United States secretary of
882	882	health and human services or other appropriate federal official for
883	883	any waiver of a requirement and make any other arrangement under
884	884	Medicare, any federally matched public health program, the
885	885	Affordable Care Act, and any other federal program that provides
886	886	federal money for payment for health care services necessary so
887	887	that:
888	888	(1) each member receives all benefits under the
889	889	program through the program;
890	890	(2) the state may implement this chapter; and
891	891	(3) the state receives all federal payments under the
892	892	applicable program, including money that may be provided in lieu of
893	893	premium tax credits, cost-sharing subsidies, and small business tax
894	894	credits.
895	895	(c) The state shall deposit money received under Subsection
896	896	(b)(3) in the state treasury to the credit of the fund and shall use
897	897	that money for the program and to implement this chapter.
898	898	(d) To the extent possible, the board shall negotiate
899	899	arrangements with the federal government to ensure that federal
900	900	payments are paid to the program in place of federal funding of, or
901	901	tax benefits for, federally matched public health programs or
902	902	federal health programs.
903	903	(e) The board may require members or applicants to provide
904	904	information necessary for the program to comply with any waiver or
905	905	arrangement under this chapter. Information provided by a member
906	906	to the board for the purposes of this subsection may not be used for
907	907	any other purpose.
908	908	(f) The board may take any additional actions necessary to
909	909	effectively fund implementation of the program to the extent
910	910	possible as a single-payer program consistent with this chapter.
911	911	(g) The board may take actions consistent with this
912	912	subchapter to enable the program to administer Medicare in this
913	913	state, and the program shall be a provider of Medicare Part B
914	914	supplemental insurance coverage and shall provide premium
915	915	assistance drug coverage under Medicare Part D for eligible members
916	916	of the program.
917	917	(h) The board may waive or modify the applicability of any
918	918	provision of this section relating to any federally matched public
919	919	health program or Medicare, as necessary, to implement any waiver
920	920	or arrangement under this section or to maximize the federal
921	921	benefits to the program under this section, provided that the
922	922	board, in consultation with the comptroller, determines that the
923	923	waiver or modification is in the best interest of the state and
924	924	members affected by the action.
925	925	(i) The board may apply for coverage for, and enroll, any
926	926	eligible member under any federally matched public health program
927	927	or Medicare. Enrollment in a federally matched public health
928	928	program or Medicare may not cause any member to lose any health care
929	929	service provided by the federal program or Medicare or diminish any
930	930	right the member would otherwise have.
931	931	(j) Notwithstanding Subsection (i) or any other law, the
932	932	board by rule shall increase the income eligibility level, increase
933	933	or eliminate the resource test for eligibility, simplify any
934	934	procedural or documentation requirement for enrollment, and
935	935	increase the benefits for any federally matched public health
936	936	program and for any program to reduce or eliminate an individual's
937	937	coinsurance, cost-sharing, or premium obligations or increase an
938	938	individual's eligibility for any federal financial support related
939	939	to Medicare or the Affordable Care Act. The board may act under
940	940	this subsection on a finding approved by the comptroller and the
941	941	board that the action:
942	942	(1) will help increase the number of members who are:
943	943	(A) eligible for and enrolled in federally
944	944	matched public health programs; or
945	945	(B) eligible for any program to reduce or
946	946	eliminate an individual's coinsurance, cost-sharing, or premium
947	947	obligations or increase an individual's eligibility for any federal
948	948	financial support related to Medicare or the Affordable Care Act;
949	949	(2) will not diminish any individual's access to any
950	950	health care service or right the individual would otherwise have;
951	951	(3) is in the interest of the program; and
952	952	(4) does not require or has received any necessary
953	953	federal waiver or approval to ensure federal financial
954	954	participation.
955	955	(k) Any action taken under Subsection (j) may not apply to
956	956	eligibility for payment for long-term care services.
957	957	(l) To enable the board to apply for coverage for and enroll
958	958	any eligible member under any federally matched public health
959	959	program or Medicare, the board may require that each member or
960	960	applicant provide the information necessary to enable the board to
961	961	determine whether the applicant is eligible for a federally matched
962	962	public health program or for Medicare, or any program or benefit
963	963	under Medicare.
964	964	(m) As a condition of continued eligibility for health care
965	965	services under the program, a member who is eligible for benefits
966	966	under Medicare must enroll in Medicare, including Parts A, B, and D.
967	967	(n) The program shall provide premium assistance for each
968	968	member enrolling in a Medicare Part D drug coverage plan under 42
969	969	U.S.C. Section 1395w-101 et seq., limited to the low-income
970	970	benchmark premium amount established by the Centers for Medicare
971	971	and Medicaid Services and any other amount the federal agency
972	972	establishes under its de minimis premium policy, except that those
973	973	payments made on behalf of a member enrolled in a Medicare advantage
974	974	plan may exceed the low-income benchmark premium amount if
975	975	determined to be cost effective to the program.
976	976	(o) If the board has reasonable grounds to believe that a
977	977	member may be eligible for an income-related subsidy under 42
978	978	U.S.C. Section 1395w-114, the member shall provide, and authorize
979	979	the program to obtain, any information or documentation required to
980	980	establish the member's eligibility for that subsidy. Before
981	981	requesting information or documentation from a member under this
982	982	section, the board shall attempt to obtain as much of the
983	983	information and documentation as possible from records that are
984	984	available to the board.
985	985	(p) The program shall make a reasonable effort to notify
986	986	each member of the member's obligations under this section. After a
987	987	reasonable effort has been made to contact the member, the member
988	988	shall be notified in writing that the member has 60 days to provide
989	989	the required information. If the member does not provide the
990	990	required information within the 60-day period, the member's
991	991	coverage under the program may be terminated. Information provided
992	992	by a member to the board for the purposes of this section may not be
993	993	used for any other purpose.
994	994	(q) The board shall assume responsibility for all benefits
995	995	and services paid for by the federal government with that money.
996	996	Sec. 1698.252. FUND; ADMINISTRATION. (a) The healthy
997	997	Texas fund is a special fund in the state treasury outside the
998	998	general revenue fund.
999	999	(b) In conjunction with the enactment of the General
1000	1000	Appropriations Act, the legislature shall develop a revenue plan,
1001	1001	taking into consideration anticipated federal revenue available
1002	1002	for the program, and appropriate money for the program as
1003	1003	necessary. In developing the revenue plan, members of the
1004	1004	legislature shall consult with appropriate officials and
1005	1005	stakeholders.
1006	1006	(c) Notwithstanding any other law, money in the fund may not
1007	1007	be loaned to or borrowed by any other special fund or the general
1008	1008	revenue fund.
1009	1009	(d) The board shall establish and maintain a prudent reserve
1010	1010	in the fund.
1011	1011	(e) The board or staff of the board may not use any money
1012	1012	intended for the administrative and operational expenses of the
1013	1013	board for staff retreats, promotional giveaways, excessive
1014	1014	executive compensation, or promotion of federal or state
1015	1015	legislative or regulatory modifications.
1016	1016	(f) Notwithstanding any other law, all interest earned on
1017	1017	the money that has been deposited into the fund is retained in the
1018	1018	fund and used for purposes consistent with the fund.
1019	1019	(g) The fund consists of:
1020	1020	(1) federal payments received as a result of any
1021	1021	waiver of requirements granted or other arrangement agreed to by
1022	1022	the United States secretary of health and human services or other
1023	1023	appropriate federal official for health care programs established
1024	1024	under Medicare, any federally matched public health program, or the
1025	1025	Affordable Care Act;
1026	1026	(2) amounts paid by the Health and Human Services
1027	1027	Commission that are equivalent to the amounts that are paid on
1028	1028	behalf of residents under Medicare, any federally matched public
1029	1029	health program, or the Affordable Care Act for health benefits that
1030	1030	are equivalent to health benefits covered under the program;
1031	1031	(3) federal and state money for purposes of the
1032	1032	provision of services authorized under Title XX of the Social
1033	1033	Security Act (42 U.S.C. Section 1397 et seq.) that would otherwise
1034	1034	be covered under the program; and
1035	1035	(4) state money that would otherwise be appropriated
1036	1036	to any governmental agency, office, program, instrumentality, or
1037	1037	institution that provides health care services for services and
1038	1038	benefits covered under the program.
1039	1039	(h) Money in the fund may be used only for the purposes
1040	1040	established in this chapter.
1041	1041	SUBCHAPTER H. COLLECTIVE NEGOTIATION AND BARGAINING
1042	1042	Sec. 1698.301. APPLICABILITY OF SUBCHAPTER. (a) This
1043	1043	subchapter applies to a health care provider that is:
1044	1044	(1) an individual who practices that profession as a
1045	1045	health care provider or as an independent contractor;
1046	1046	(2) an owner, officer, shareholder, or proprietor of a
1047	1047	health care provider; or
1048	1048	(3) an entity that employs or uses health care
1049	1049	providers to provide health care services, including a health
1050	1050	facility licensed under the Health and Safety Code.
1051	1051	(b) A health care provider under Title 3, Occupations Code,
1052	1052	who practices as an employee of a health care provider is not a
1053	1053	health care provider for purposes of this subchapter.
1054	1054	Sec. 1698.302. COLLECTIVE NEGOTIATION AUTHORIZED. (a)
1055	1055	Health care providers may meet and communicate for the purpose of
1056	1056	collectively negotiating with the program on any matter relating to
1057	1057	the program, including rates of payment for health care services,
1058	1058	rates of payment for prescription and nonprescription drugs, and
1059	1059	payment methodologies.
1060	1060	(b) This subchapter may not be construed to allow or
1061	1061	authorize:
1062	1062	(1) an alteration of the terms of the internal and
1063	1063	external review procedures prescribed by law;
1064	1064	(2) a strike of the program by health care providers
1065	1065	related to the collective negotiations; or
1066	1066	(3) terms or conditions that would impede the ability
1067	1067	of the program to obtain or retain accreditation by the National
1068	1068	Committee for Quality Assurance or a similar body, or to comply with
1069	1069	applicable state or federal law.
1070	1070	Sec. 1698.303. COLLECTIVE NEGOTIATION. (a) Collective
1071	1071	negotiation rights granted by this subchapter must provide that:
1072	1072	(1) a health care provider may communicate with other
1073	1073	health care providers regarding the terms and conditions to be
1074	1074	negotiated with the program;
1075	1075	(2) a health care provider may communicate with a
1076	1076	health care providers' representative;
1077	1077	(3) a health care providers' representative is the
1078	1078	only party authorized to negotiate with the program on behalf of the
1079	1079	health care providers as a group;
1080	1080	(4) a health care provider may be bound by the terms
1081	1081	and conditions negotiated by the health care providers'
1082	1082	representative; and
1083	1083	(5) in communicating or negotiating with the health
1084	1084	care providers' representative, the program is entitled to offer
1085	1085	and provide different terms and conditions to individual competing
1086	1086	health care providers.
1087	1087	(b) This subchapter does not affect or limit:
1088	1088	(1) the right of a health care provider or group of
1089	1089	health care providers to collectively petition a governmental
1090	1090	entity for a change in a law or board rule; or
1091	1091	(2) collective action or collective bargaining on the
1092	1092	part of a health care provider with that health care provider's
1093	1093	employer or any other lawful collective action or collective
1094	1094	bargaining.
1095	1095	Sec. 1698.304. DUTIES OF HEALTH CARE PROVIDERS'
1096	1096	REPRESENTATIVE. (a) Before engaging in collective negotiations
1097	1097	with the program on behalf of health care providers, a health care
1098	1098	providers' representative shall file with the board, in the manner
1099	1099	prescribed by the board, information identifying the
1100	1100	representative, the representative's plan of operation, and the
1101	1101	representative's procedures to ensure compliance with this
1102	1102	subchapter.
1103	1103	(b) Each person who acts as the representative of a
1104	1104	negotiating party under this subchapter shall pay a fee, as adopted
1105	1105	by board rule, to the board to act as a representative.
1106	1106	Sec. 1698.305. PROHIBITED COLLECTIVE ACTION. (a) This
1107	1107	subchapter does not authorize competing health care providers to
1108	1108	act in concert in response to a health care providers'
1109	1109	representative's discussions or negotiations with the program,
1110	1110	except as authorized by other law.
1111	1111	(b) A health care providers' representative may not
1112	1112	negotiate any agreement that excludes, limits the participation or
1113	1113	reimbursement of, or otherwise limits the scope of services to be
1114	1114	provided by any health care provider or group of health care
1115	1115	providers with respect to the performance of services that are
1116	1116	within the health care provider's scope of practice, license,
1117	1117	registration, or certificate.
1118	1118	SECTION 2. Not later than two years after the effective date
1119	1119	of this Act, the Healthy Texas Board created by this Act shall:
1120	1120	(1) in consultation with an advisory committee
1121	1121	appointed by the chairperson of the board, including
1122	1122	representatives of consumers and potential consumers of long-term
1123	1123	care services, providers of long-term care services, members of
1124	1124	organized labor, and other interested parties, develop a proposal
1125	1125	consistent with the principles of Chapter 1698, Insurance Code, as
1126	1126	added by this Act, for providing and funding long-term care
1127	1127	services coverage by the Healthy Texas Program;
1128	1128	(2) develop a proposal for accommodating employer
1129	1129	retiree health benefits for people who have been members of the
1130	1130	Healthy Texas Program but live as retirees outside this state;
1131	1131	(3) develop a proposal for accommodating employer
1132	1132	retiree health benefits for people who earned or accrued those
1133	1133	benefits while residing in this state before the implementation of
1134	1134	the Healthy Texas Program and live as retirees outside this state;
1135	1135	and
1136	1136	(4) develop a proposal for Healthy Texas Program
1137	1137	coverage of health care services currently covered under the
1138	1138	workers' compensation system, including whether and how to continue
1139	1139	funding for those services under that system and whether and how to
1140	1140	incorporate an element of experience rating.
1141	1141	SECTION 3. (a) The Healthy Texas Board created by this Act
1142	1142	shall determine when individuals may begin enrolling in the Healthy
1143	1143	Texas Program. An implementation period begins on the date that
1144	1144	individuals may begin enrolling in the program and ends on a date
1145	1145	determined by the board. During the implementation period, the
1146	1146	Healthy Texas Program is subject to special eligibility and
1147	1147	financing provisions determined by the board until the program is
1148	1148	fully implemented.
1149	1149	(b) This Act does not prohibit a health benefit plan issuer
1150	1150	from offering any benefits during the implementation period to
1151	1151	individuals who enrolled or may enroll as members of the Healthy
1152	1152	Texas Program.
1153	1153	(c) Before full implementation of the Healthy Texas
1154	1154	Program, the board shall provide for the collection and
1155	1155	availability of data on the number of patients served by hospitals
1156	1156	and the dollar value of the care provided, at cost, for the
1157	1157	following categories:
1158	1158	(1) patients receiving charity care;
1159	1159	(2) contractual adjustments of county and indigent
1160	1160	programs, including traditional and managed care; and
1161	1161	(3) bad debts.
1162	1162	(d) Notwithstanding Section 1698.054(b), Insurance Code, as
1163	1163	added by this Act, a board member is not required to enroll as a
1164	1164	member of the Healthy Texas Program until the implementation period
1165	1165	has ended.
1166	1166	SECTION 4. The Healthy Texas Board created by this Act shall
1167	1167	provide money from the healthy Texas fund established by Section
1168	1168	1698.252, Insurance Code, as added by this Act or from funds
1169	1169	otherwise appropriated for this purpose to the Texas Workforce
1170	1170	Commission for a program for retraining and assisting job
1171	1171	transition for individuals employed or previously employed in the
1172	1172	fields of health insurance, health care service plans, and other
1173	1173	third-party payments for health care or those individuals providing
1174	1174	services to health care providers to deal with third-party payers
1175	1175	for health care, whose jobs may be ending or have ended as a result
1176	1176	of the implementation of the Healthy Texas Program.
1177	1177	SECTION 5. (a) Notwithstanding any other law, Chapter 1698,
1178	1178	Insurance Code, as added by this Act, may not be implemented until
1179	1179	the date the executive commissioner of the Health and Human
1180	1180	Services Commission notifies the secretary of the Texas Senate and
1181	1181	the chief clerk of the Texas House of Representatives in writing
1182	1182	that the executive commissioner has determined that the healthy
1183	1183	Texas fund has the revenue to fund the costs of implementing Chapter
1184	1184	1698.
1185	1185	(b) The Health and Human Services Commission shall publish a
1186	1186	copy of the notice required by Subsection (a) of this section on the
1187	1187	commission's Internet website.
1188	1188	SECTION 6. This Act takes effect September 1, 2019.