Texas 2021 - 87th Regular

Texas House Bill HB2981 Compare Versions

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

Old	New	Differences
1	1	87R12454 SCL-F
2	2	By: Oliverson H.B. No. 2981
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to establishment of the prescription drug savings program
8	8	for certain uninsured individuals.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. This Act shall be known as the "Texas Cares Act."
11	11	SECTION 2. Subtitle C, Title 2, Health and Safety Code, is
12	12	amended by adding Chapter 65 to read as follows:
13	13	CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN
14	14	UNINSURED INDIVIDUALS
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 65.001. DEFINITIONS. In this chapter:
17	17	(1) "Account" means the Texas cares account
18	18	established under Section 65.101.
19	19	(2) "Enrollee" means an individual enrolled in the
20	20	program.
21	21	(3) "Pharmacy benefit manager" means a person, other
22	22	than a pharmacy or pharmacist, who acts as an administrator in
23	23	connection with prescription drug discounts provided under the
24	24	program.
25	25	(4) "Program" means the prescription drug savings
26	26	program established under this chapter.
27	27	(5) "Uninsured individual" means an individual
28	28	without health benefit plan coverage for a prescription drug
29	29	benefit.
30	30	Sec. 65.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This
31	31	chapter does not establish an entitlement to assistance in
32	32	obtaining benefits for uninsured individuals.
33	33	(b) The purpose of this chapter is to make this state's risk
34	34	pool whole by providing services to uninsured individuals without
35	35	access to prescription drug benefits.
36	36	Sec. 65.003. CONFLICT WITH FEDERAL LAW; REPORT. (a) The
37	37	executive commissioner shall monitor federal law affecting the
38	38	administration or facilitation of a prescription drug savings
39	39	program.
40	40	(b) If the executive commissioner determines that a federal
41	41	law, rule, or regulation conflicts with this chapter, the executive
42	42	commissioner shall provide a written report of the conflict to the
43	43	governor, lieutenant governor, and speaker of the house of
44	44	representatives. The report must include recommendations for
45	45	legislation necessary to comply with federal law or recommendations
46	46	for dissolution of a program established by this chapter that is
47	47	duplicative of federal law.
48	48	Sec. 65.004. RULES. (a) Except as provided by Subsection
49	49	(b), the executive commissioner shall adopt rules as necessary to
50	50	implement this chapter.
51	51	(b) The executive commissioner may delegate rulemaking to
52	52	another state agency with that agency's approval. If the executive
53	53	commissioner delegates rulemaking under this subsection, the
54	54	executive commissioner must approve the proposed rules of the
55	55	delegated agency before the delegated agency adopts the rules.
56	56	SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION
57	57	DRUG SAVINGS PROGRAM
58	58	Sec. 65.051. ESTABLISHMENT OF PROGRAM. (a) The commission
59	59	shall develop and design a prescription drug savings program that
60	60	partners with a pharmacy benefit manager to make prescription drugs
61	61	available at a discounted rate to uninsured individuals.
62	62	(b) In developing and implementing the program, the
63	63	commission shall ensure that program benefits do not include
64	64	prescription drugs to be used for the elective termination of a
65	65	pregnancy.
66	66	(c) The executive commissioner shall ensure that the
67	67	program is designed in a manner that provides the greatest possible
68	68	value to the uninsured individuals it serves, with considerations
69	69	given to the adequacy of the prescription drug formulary, costs of
70	70	drugs, cost to the state, and other important factors.
71	71	Sec. 65.052. GENERAL DUTIES OF COMMISSION RELATED TO
72	72	PROGRAM. (a) The commission shall oversee the implementation of
73	73	the program and coordinate the activities of each state agency
74	74	necessary for the implementation of the program, including the
75	75	Texas Department of Insurance.
76	76	(b) The commission shall maximize the use of private
77	77	resources in administering the program.
78	78	(c) The commission shall ensure that money spent
79	79	administering the program does not exceed a limit on program
80	80	expenditures imposed by the legislature.
81	81	(d) The commission shall develop a method to accept
82	82	applications for participation in the program, including a process
83	83	to:
84	84	(1) determine eligibility, screening, and enrollment
85	85	procedures; and
86	86	(2) resolve disputes related to eligibility
87	87	determinations.
88	88	Sec. 65.053. TEXAS DEPARTMENT OF INSURANCE DUTIES. At the
89	89	request of the commission, the Texas Department of Insurance shall
90	90	provide any necessary assistance with the development of the
91	91	program. The Texas Department of Insurance shall monitor the
92	92	quality of the services provided by a pharmacy benefit manager and
93	93	resolve disputes relating to those services.
94	94	Sec. 65.054. PHARMACY BENEFIT MANAGER CONTRACT AND
95	95	REQUIREMENTS. (a) The commission shall enter into a contract with
96	96	a pharmacy benefit manager to provide enrollment and related
97	97	services throughout this state under the program.
98	98	(b) The commission shall monitor, through reporting
99	99	requirements or other means, the contracted pharmacy benefit
100	100	manager to ensure performance under the contract and quality
101	101	delivery of services.
102	102	(c) The commission shall provide payments under a contract
103	103	entered into under this section to the contracted pharmacy benefit
104	104	manager.
105	105	(d) A pharmacy benefit manager must hold a certificate of
106	106	authority or other appropriate license issued by the Texas
107	107	Department of Insurance that authorizes the pharmacy benefit
108	108	manager to provide the type of coverage related to the services
109	109	provided under the program.
110	110	(e) A pharmacy benefit manager that provides health care
111	111	services under the program must satisfy certification and licensure
112	112	requirements prescribed by the commission and consistent with law.
113	113	Sec. 65.055. CONTRACT ADMINISTRATION. (a) The commission
114	114	may contract with a third-party administrator or other entity to
115	115	administer the program for the commission under this chapter.
116	116	(b) A third-party administrator or other entity may perform
117	117	tasks under a contract entered into under Subsection (a) that would
118	118	otherwise be performed by the commission.
119	119	(c) The commission may not delegate decisions about the
120	120	policies of the program to a third party administrator or other
121	121	entity.
122	122	Sec. 65.056. CONTRACT OVERSIGHT. (a) The commission shall
123	123	conduct a review of each entity that enters into a contract under
124	124	this subchapter to ensure the entity is available, prepared, and
125	125	able to fulfill the entity's obligations under the contract in
126	126	compliance with the contract, this chapter, and rules adopted under
127	127	this chapter.
128	128	(b) The commission's review of contractors under Subsection
129	129	(a) must be based on the following criteria:
130	130	(1) adequate and appropriate staffing, including
131	131	contracts with third parties;
132	132	(2) adequate and properly documented policies and
133	133	procedures;
134	134	(3) fiscal soundness; and
135	135	(4) adequate information systems, electronic
136	136	interfaces, and business practices.
137	137	(c) The commission shall ensure that each contract entered
138	138	into under this subchapter is procured using a competitive
139	139	procurement process in compliance with all applicable federal and
140	140	state laws, rules, and regulations.
141	141	Sec. 65.057. COMMUNITY OUTREACH CAMPAIGN. The commission
142	142	shall conduct a community outreach and education campaign in the
143	143	form and manner determined by the commission to provide information
144	144	relating to the availability of the program.
145	145	SUBCHAPTER C. TEXAS CARES ACCOUNT; PROGRAM TERMINATION
146	146	Sec. 65.101. ESTABLISHMENT OF TEXAS CARES ACCOUNT. (a)
147	147	The Texas cares account is a dedicated account in the general
148	148	revenue fund.
149	149	(b) The account consists of:
150	150	(1) gifts, grants, and donations received for the
151	151	account;
152	152	(2) legislative appropriations;
153	153	(3) federal money available to be used for this
154	154	purpose; and
155	155	(4) interest, dividends, and other income of the
156	156	account.
157	157	(c) Section 403.0956, Government Code, does not apply to the
158	158	account.
159	159	(d) Money in the account may be appropriated only for the
160	160	administration of the program and the provision of program
161	161	services.
162	162	(e) The commission may solicit and accept gifts, grants, and
163	163	donations for the account.
164	164	Sec. 65.102. TERMINATION OF PROGRAM. The commission may
165	165	terminate the program if the commission determines the account
166	166	under Section 65.101 lacks sufficient funding to administer the
167	167	program.
168	168	SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS
169	169	Sec. 65.151. ELIGIBILITY CRITERIA. (a) Except as provided
170	170	by Subsection (b), an individual is eligible for benefits under the
171	171	program if the individual:
172	172	(1) is a resident of this state;
173	173	(2) is a citizen of the United States; and
174	174	(3) is uninsured, as determined by the commission.
175	175	(b) If the commission determines necessary, the commission
176	176	may consider an applicant's financial vulnerability as an
177	177	additional factor for determining program eligibility.
178	178	(c) The executive commissioner by rule shall establish
179	179	eligibility levels consistent with any other applicable federal and
180	180	state laws, rules, and regulations.
181	181	Sec. 65.152. COST SHARING. To the extent necessary, the
182	182	commission shall require enrollees to share the cost of the
183	183	program, including provisions requiring enrollees to pay a
184	184	copayment at the point of service.
185	185	SUBCHAPTER E. OPERATION OF PROGRAM
186	186	Sec. 65.201. PROGRAM BENEFITS. (a) The commission may use
187	187	money appropriated to the program in accordance with the General
188	188	Appropriations Act and in the account to finance benefits for
189	189	enrollees.
190	190	(b) The commission must approve program benefits offered
191	191	under this chapter. The commission shall ensure that the benefits
192	192	comply with all applicable federal and state laws, rules, and
193	193	regulations.
194	194	Sec. 65.202. REPORTING. (a) A third-party administrator
195	195	or other entity the commission contracts with under Section 65.055
196	196	shall report to the commission in the form and manner prescribed by
197	197	the commission on the benefits and services provided under the
198	198	program.
199	199	(b) The commission shall establish a procedure to monitor
200	200	the provision of benefits and services under this chapter.
201	201	Sec. 65.203. FRAUD PREVENTION. The executive commissioner
202	202	shall develop and implement rules for the prevention and detection
203	203	of fraud in the program.
204	204	SECTION 3. (a) In this section, "commission" means the
205	205	Health and Human Services Commission.
206	206	(b) The commission shall conduct a study on the development
207	207	and implementation of the prescription drug savings program
208	208	established by Chapter 65, Health and Safety Code, as added by this
209	209	Act. The commission shall determine the effectiveness of the
210	210	program in providing services to uninsured individuals in this
211	211	state and any legislative recommendations for improvements to the
212	212	program.
213	213	(c) Not later than October 16, 2022, the commission shall
214	214	provide a written report of the results of the study conducted under
215	215	Subsection (b) of this section to the governor, lieutenant
216	216	governor, speaker of the house of representatives, and members of
217	217	the standing committees of the legislature with primary
218	218	jurisdiction over the commission.
219	219	SECTION 4. As soon as practicable after the effective date
220	220	of this Act, the executive commissioner of the Health and Human
221	221	Services Commission and any other state agency designated by the
222	222	executive commissioner shall adopt rules necessary to implement
223	223	Chapter 65, Health and Safety Code, as added by this Act.
224	224	SECTION 5. This Act takes effect September 1, 2021.