87R12454 SCL-F
By: Oliverson H.B. No. 18
A BILL TO BE ENTITLED
AN ACT
relating to establishment of the prescription drug savings program
for certain uninsured individuals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. This Act shall be known as the "Texas Cares Act."
SECTION 2. Subtitle C, Title 2, Health and Safety Code, is
amended by adding Chapter 65 to read as follows:
CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN
UNINSURED INDIVIDUALS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 65.001. DEFINITIONS. In this chapter:
(1) "Account" means the Texas cares account
established under Section 65.101.
(2) "Enrollee" means an individual enrolled in the
program.
(3) "Pharmacy benefit manager" means a person, other
than a pharmacy or pharmacist, who acts as an administrator in
connection with prescription drug discounts provided under the
program.
(4) "Program" means the prescription drug savings
program established under this chapter.
(5) "Uninsured individual" means an individual
without health benefit plan coverage for a prescription drug
benefit.
Sec. 65.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This
chapter does not establish an entitlement to assistance in
obtaining benefits for uninsured individuals.
(b) The purpose of this chapter is to make this state's risk
pool whole by providing services to uninsured individuals without
access to prescription drug benefits.
Sec. 65.003. CONFLICT WITH FEDERAL LAW; REPORT. (a) The
executive commissioner shall monitor federal law affecting the
administration or facilitation of a prescription drug savings
program.
(b) If the executive commissioner determines that a federal
law, rule, or regulation conflicts with this chapter, the executive
commissioner shall provide a written report of the conflict to the
governor, lieutenant governor, and speaker of the house of
representatives. The report must include recommendations for
legislation necessary to comply with federal law or recommendations
for dissolution of a program established by this chapter that is
duplicative of federal law.
Sec. 65.004. RULES. (a) Except as provided by Subsection
(b), the executive commissioner shall adopt rules as necessary to
implement this chapter.
(b) The executive commissioner may delegate rulemaking to
another state agency with that agency's approval. If the executive
commissioner delegates rulemaking under this subsection, the
executive commissioner must approve the proposed rules of the
delegated agency before the delegated agency adopts the rules.
SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION
DRUG SAVINGS PROGRAM
Sec. 65.051. ESTABLISHMENT OF PROGRAM. (a) The commission
shall develop and design a prescription drug savings program that
partners with a pharmacy benefit manager to make prescription drugs
available at a discounted rate to uninsured individuals.
(b) In developing and implementing the program, the
commission shall ensure that program benefits do not include
prescription drugs to be used for the elective termination of a
pregnancy.
(c) The executive commissioner shall ensure that the
program is designed in a manner that provides the greatest possible
value to the uninsured individuals it serves, with considerations
given to the adequacy of the prescription drug formulary, costs of
drugs, cost to the state, and other important factors.
Sec. 65.052. GENERAL DUTIES OF COMMISSION RELATED TO
PROGRAM. (a) The commission shall oversee the implementation of
the program and coordinate the activities of each state agency
necessary for the implementation of the program, including the
Texas Department of Insurance.
(b) The commission shall maximize the use of private
resources in administering the program.
(c) The commission shall ensure that money spent
administering the program does not exceed a limit on program
expenditures imposed by the legislature.
(d) The commission shall develop a method to accept
applications for participation in the program, including a process
to:
(1) determine eligibility, screening, and enrollment
procedures; and
(2) resolve disputes related to eligibility
determinations.
Sec. 65.053. TEXAS DEPARTMENT OF INSURANCE DUTIES. At the
request of the commission, the Texas Department of Insurance shall
provide any necessary assistance with the development of the
program. The Texas Department of Insurance shall monitor the
quality of the services provided by a pharmacy benefit manager and
resolve disputes relating to those services.
Sec. 65.054. PHARMACY BENEFIT MANAGER CONTRACT AND
REQUIREMENTS. (a) The commission shall enter into a contract with
a pharmacy benefit manager to provide enrollment and related
services throughout this state under the program.
(b) The commission shall monitor, through reporting
requirements or other means, the contracted pharmacy benefit
manager to ensure performance under the contract and quality
delivery of services.
(c) The commission shall provide payments under a contract
entered into under this section to the contracted pharmacy benefit
manager.
(d) A pharmacy benefit manager must hold a certificate of
authority or other appropriate license issued by the Texas
Department of Insurance that authorizes the pharmacy benefit
manager to provide the type of coverage related to the services
provided under the program.
(e) A pharmacy benefit manager that provides health care
services under the program must satisfy certification and licensure
requirements prescribed by the commission and consistent with law.
Sec. 65.055. CONTRACT ADMINISTRATION. (a) The commission
may contract with a third-party administrator or other entity to
administer the program for the commission under this chapter.
(b) A third-party administrator or other entity may perform
tasks under a contract entered into under Subsection (a) that would
otherwise be performed by the commission.
(c) The commission may not delegate decisions about the
policies of the program to a third party administrator or other
entity.
Sec. 65.056. CONTRACT OVERSIGHT. (a) The commission shall
conduct a review of each entity that enters into a contract under
this subchapter to ensure the entity is available, prepared, and
able to fulfill the entity's obligations under the contract in
compliance with the contract, this chapter, and rules adopted under
this chapter.
(b) The commission's review of contractors under Subsection
(a) must be based on the following criteria:
(1) adequate and appropriate staffing, including
contracts with third parties;
(2) adequate and properly documented policies and
procedures;
(3) fiscal soundness; and
(4) adequate information systems, electronic
interfaces, and business practices.
(c) The commission shall ensure that each contract entered
into under this subchapter is procured using a competitive
procurement process in compliance with all applicable federal and
state laws, rules, and regulations.
Sec. 65.057. COMMUNITY OUTREACH CAMPAIGN. The commission
shall conduct a community outreach and education campaign in the
form and manner determined by the commission to provide information
relating to the availability of the program.
SUBCHAPTER C. TEXAS CARES ACCOUNT; PROGRAM TERMINATION
Sec. 65.101. ESTABLISHMENT OF TEXAS CARES ACCOUNT. (a)
The Texas cares account is a dedicated account in the general
revenue fund.
(b) The account consists of:
(1) gifts, grants, and donations received for the
account;
(2) legislative appropriations;
(3) federal money available to be used for this
purpose; and
(4) interest, dividends, and other income of the
account.
(c) Section 403.0956, Government Code, does not apply to the
account.
(d) Money in the account may be appropriated only for the
administration of the program and the provision of program
services.
(e) The commission may solicit and accept gifts, grants, and
donations for the account.
Sec. 65.102. TERMINATION OF PROGRAM. The commission may
terminate the program if the commission determines the account
under Section 65.101 lacks sufficient funding to administer the
program.
SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS
Sec. 65.151. ELIGIBILITY CRITERIA. (a) Except as provided
by Subsection (b), an individual is eligible for benefits under the
program if the individual:
(1) is a resident of this state;
(2) is a citizen of the United States; and
(3) is uninsured, as determined by the commission.
(b) If the commission determines necessary, the commission
may consider an applicant's financial vulnerability as an
additional factor for determining program eligibility.
(c) The executive commissioner by rule shall establish
eligibility levels consistent with any other applicable federal and
state laws, rules, and regulations.
Sec. 65.152. COST SHARING. To the extent necessary, the
commission shall require enrollees to share the cost of the
program, including provisions requiring enrollees to pay a
copayment at the point of service.
SUBCHAPTER E. OPERATION OF PROGRAM
Sec. 65.201. PROGRAM BENEFITS. (a) The commission may use
money appropriated to the program in accordance with the General
Appropriations Act and in the account to finance benefits for
enrollees.
(b) The commission must approve program benefits offered
under this chapter. The commission shall ensure that the benefits
comply with all applicable federal and state laws, rules, and
regulations.
Sec. 65.202. REPORTING. (a) A third-party administrator
or other entity the commission contracts with under Section 65.055
shall report to the commission in the form and manner prescribed by
the commission on the benefits and services provided under the
program.
(b) The commission shall establish a procedure to monitor
the provision of benefits and services under this chapter.
Sec. 65.203. FRAUD PREVENTION. The executive commissioner
shall develop and implement rules for the prevention and detection
of fraud in the program.
SECTION 3. (a) In this section, "commission" means the
Health and Human Services Commission.
(b) The commission shall conduct a study on the development
and implementation of the prescription drug savings program
established by Chapter 65, Health and Safety Code, as added by this
Act. The commission shall determine the effectiveness of the
program in providing services to uninsured individuals in this
state and any legislative recommendations for improvements to the
program.
(c) Not later than October 16, 2022, the commission shall
provide a written report of the results of the study conducted under
Subsection (b) of this section to the governor, lieutenant
governor, speaker of the house of representatives, and members of
the standing committees of the legislature with primary
jurisdiction over the commission.
SECTION 4. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission and any other state agency designated by the
executive commissioner shall adopt rules necessary to implement
Chapter 65, Health and Safety Code, as added by this Act.
SECTION 5. This Act takes effect September 1, 2021.