Texas 2021 - 87th Regular

Texas House Bill HB602 Compare Versions

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

Old	New	Differences
1	1	87R269 JES-F
2	2	By: Hinojosa H.B. No. 602
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the provision of comprehensive health care benefits
8	8	coverage through a publicly funded program to be known as the
9	9	Healthy Texas Program; authorizing a fee.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Title 8, Insurance Code, is amended by adding
12	12	Subtitle N to read as follows:
13	13	SUBTITLE N. HEALTHY TEXAS PROGRAM
14	14	CHAPTER 1698. HEALTHY TEXAS PROGRAM
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 1698.0001. DEFINITIONS. Unless the context indicates
17	17	otherwise, in this chapter:
18	18	(1) "Affordable Care Act" means the Patient Protection
19	19	and Affordable Care Act (Pub. L. No. 111-148).
20	20	(2) "Allied health practitioner":
21	21	(A) means a health care professional who:
22	22	(i) works to prevent disease transmission,
23	23	or diagnose, treat, or rehabilitate individuals; and
24	24	(ii) delivers direct patient care,
25	25	rehabilitation, treatment, diagnostics, and health improvement
26	26	interventions to restore and maintain optimal physical, sensory,
27	27	psychological, cognitive, and social functions; and
28	28	(B) includes technical and support staff,
29	29	audiologists, occupational therapists, social workers, and
30	30	radiographers.
31	31	(3) "Board" means the Healthy Texas Board established
32	32	under Section 1698.0051.
33	33	(4) "Care coordination" means the services described
34	34	by Section 1698.0152.
35	35	(5) "Care coordinator" means a person approved by the
36	36	board to provide care coordination.
37	37	(6) "Child health plan program" means the state
38	38	children's health insurance program established under Title XXI,
39	39	Social Security Act (42 U.S.C. Section 1397aa et seq.), or the
40	40	programs established under Chapters 62 and 63, Health and Safety
41	41	Code, as appropriate.
42	42	(7) "Essential community provider" means a person
43	43	acting as a safety net clinic, safety net health care provider, or
44	44	rural hospital.
45	45	(8) "Federally matched public health program" means:
46	46	(A) Medicaid; or
47	47	(B) the child health plan program.
48	48	(9) "Fund" means the healthy Texas fund established
49	49	under Section 1698.0305.
50	50	(10) "Health benefit plan issuer" means an insurance
51	51	company, health maintenance organization, or other entity
52	52	regulated by the department and authorized to issue a health
53	53	insurance policy or other health benefit plan. The term includes:
54	54	(A) a stock life, health, or accident insurance
55	55	company;
56	56	(B) a mutual life, health, or accident insurance
57	57	company;
58	58	(C) a stock casualty insurance company;
59	59	(D) a mutual casualty insurance company;
60	60	(E) a Lloyd's plan;
61	61	(F) a reciprocal or interinsurance exchange;
62	62	(G) a fraternal benefit society;
63	63	(H) a stipulated premium company; and
64	64	(I) a nonprofit hospital, medical, or dental
65	65	service corporation, including a company subject to Chapter 842.
66	66	(11) "Health care organization" means a
67	67	not-for-profit or public organization that is approved by the board
68	68	to provide health care services to members under the program.
69	69	(12) "Health care provider" means a person that is
70	70	licensed, certified, or otherwise authorized by the laws of this
71	71	state to provide health care services in the ordinary course of
72	72	business or practice of a profession.
73	73	(13) "Health care providers' representative" means a
74	74	third party that is authorized by health care providers to
75	75	negotiate on their behalf with the program related to terms and
76	76	conditions affecting those health care providers.
77	77	(14) "Health care service" means any health care
78	78	service, including care coordination, that is included as a benefit
79	79	under the program.
80	80	(15) "Integrated health care delivery system" means a
81	81	provider organization that is:
82	82	(A) fully integrated operationally and
83	83	clinically to provide a broad range of health care services,
84	84	including preventive care, prenatal and well-baby care,
85	85	immunizations, screening diagnostics, emergency services, hospital
86	86	and medical services, surgical services, and ancillary services;
87	87	and
88	88	(B) compensated by the program using capitation
89	89	or facility budgets for the provision of health care services.
90	90	(16) "Long-term care services" has the meaning
91	91	assigned by Section 22.0011, Human Resources Code.
92	92	(17) "Medicaid" means the medical assistance program
93	93	established under Title XIX, Social Security Act (42 U.S.C. Section
94	94	1396 et seq.), or the medical assistance program established under
95	95	Chapter 32, Human Resources Code, as appropriate.
96	96	(18) "Medicare" means the Health Insurance for the
97	97	Aged and Disabled Act under Title XVIII of the Social Security Act
98	98	(42 U.S.C. Section 1395 et seq.).
99	99	(19) "Member" means an individual who is enrolled in
100	100	the program.
101	101	(20) "Out-of-state health care service":
102	102	(A) means a health care service that:
103	103	(i) is provided in person to a member while
104	104	the member is physically located outside this state; and
105	105	(ii) is:
106	106	(a) medically necessary to be
107	107	provided while the member is physically outside this state; or
108	108	(b) clinically appropriate and
109	109	necessary and cannot be provided in this state because the health
110	110	care service can be provided only by a particular health care
111	111	provider physically located outside this state; and
112	112	(B) does not include a health care service
113	113	provided to a member by a health care provider qualified under
114	114	Section 1698.0201 that is physically located outside this state.
115	115	(21) "Participating provider" means:
116	116	(A) a health care provider qualified under
117	117	Section 1698.0201 that provides health care services to members
118	118	under the program; or
119	119	(B) a health care organization.
120	120	(22) "Prescription drug" has the meaning assigned by
121	121	Section 551.003, Occupations Code.
122	122	(23) "Program" means the Healthy Texas Program
123	123	established under this chapter.
124	124	(24) "Resident" means an individual whose primary
125	125	place of residence is located in this state without regard to the
126	126	individual's immigration status.
127	127	Sec. 1698.0002. COVERAGE NOT EXCLUSIVE. This chapter does
128	128	not preempt a political subdivision from adopting additional health
129	129	care coverage that provides additional protections and benefits to
130	130	residents in the political subdivision's jurisdiction.
131	131	Sec. 1698.0003. CONFLICT WITH OTHER LAW. (a) To the extent
132	132	any provision of state law is inconsistent with this chapter, this
133	133	chapter prevails, except as explicitly provided otherwise by this
134	134	chapter.
135	135	(b) This chapter may not be construed to alter in any way the
136	136	professional practice of health care providers or licensure
137	137	standards established under Title 3, Occupations Code.
138	138	SUBCHAPTER B. HEALTHY TEXAS BOARD
139	139	Sec. 1698.0051. HEALTHY TEXAS BOARD. The Healthy Texas
140	140	Board is an agency of this state.
141	141	Sec. 1698.0052. COMPOSITION OF BOARD. The board is
142	142	composed of the following nine members:
143	143	(1) four appointed by the governor;
144	144	(2) two appointed by the lieutenant governor;
145	145	(3) two appointed by the speaker of the house of
146	146	representatives; and
147	147	(4) the executive commissioner of the Health and Human
148	148	Services Commission, or the executive commissioner's designee, who
149	149	serves as a voting, ex officio member.
150	150	Sec. 1698.0053. TERM; VACANCY. (a) Board members other
151	151	than an ex officio member shall be appointed for a term of two
152	152	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. 1698.0054. 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 program member. This subsection does not apply to
162	162	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	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	this state and attempt to make appointments so that the board's
180	180	composition reflects the communities of this state.
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	Sec. 1698.0055. BOARD MEMBER COMPENSATION. A board member
191	191	may not receive compensation but is entitled to reimbursement of
192	192	the travel expenses incurred by the board member while conducting
193	193	board business, as provided in the General Appropriations Act.
194	194	Sec. 1698.0056. CONFLICT OF INTEREST. (a) A board member
195	195	may not make, participate in making, or in any way attempt to make
196	196	use of the board member's official position to influence the making
197	197	of a decision the board member knows or has reason to know will have
198	198	a material financial effect, distinguishable from its effect on the
199	199	public generally, on:
200	200	(1) the board member or the board member's immediate
201	201	family;
202	202	(2) a person or entity that was the source of a benefit
203	203	aggregating $250 or more in value received by or promised to the
204	204	board member within 12 months before the date the decision is made;
205	205	or
206	206	(3) a business entity in which the board member is a
207	207	director, officer, partner, trustee, or employee, or holds any
208	208	management position.
209	209	(b) For purposes of Subsection (a), "benefit" has the
210	210	meaning assigned by Section 36.01, Penal Code, but does not
211	211	include:
212	212	(1) a gift; or
213	213	(2) a loan by a commercial lending institution in the
214	214	regular course of business on terms available to the public.
215	215	(c) A board member, officer, or employee may not:
216	216	(1) be employed by, be a consultant to, be a member of
217	217	the board of directors of, be affiliated with, or otherwise be a
218	218	representative of a health care provider, a health care facility,
219	219	or a health clinic while serving as a board member, officer, or
220	220	employee;
221	221	(2) be a member, a board member, or an employee of a
222	222	trade association of health care facilities, health clinics, or
223	223	health care providers while serving as a board member, officer, or
224	224	employee; or
225	225	(3) be a health care provider unless the board member,
226	226	officer, or employee receives no compensation for providing
227	227	services as a health care provider and does not have an ownership
228	228	interest in a health care practice.
229	229	Sec. 1698.0057. IMMUNITY. The following persons are not
230	230	liable, and a cause of action does not arise against any of the
231	231	following persons, for a good faith act or omission in exercising
232	232	powers and performing duties under this chapter:
233	233	(1) the board;
234	234	(2) a board member; or
235	235	(3) a board officer or employee.
236	236	Sec. 1698.0058. BOARD ELECTION. The board annually shall
237	237	elect a chairperson.
238	238	Sec. 1698.0059. EXECUTIVE DIRECTOR. The board shall hire
239	239	an executive director to organize, administer, and manage the
240	240	program and board operations. The executive director serves at the
241	241	pleasure of the board.
242	242	Sec. 1698.0060. OPEN MEETINGS; OPEN RECORDS. The board is
243	243	subject to Chapters 551 and 552, Government Code. The board may
244	244	conduct a closed meeting to deliberate:
245	245	(1) business and financial issues relating to a
246	246	contract being negotiated; or
247	247	(2) rates to be paid under the program.
248	248	Sec. 1698.0061. RULES. (a) The board may adopt rules
249	249	necessary to implement and enforce this chapter.
250	250	(b) The board by rule shall set fees in amounts reasonable
251	251	and necessary to implement this chapter.
252	252	(c) The board by rule shall establish dispute resolution
253	253	procedures to address member disputes. Dispute resolution
254	254	procedures must:
255	255	(1) include a patient advocate to assist members in
256	256	the dispute resolution process; and
257	257	(2) provide for a member to withdraw from the program.
258	258	(d) The board may adopt narrowly focused rules relating
259	259	solely to health care organizations for the specific purpose of
260	260	ensuring consistent compliance with this chapter.
261	261	Sec. 1698.0062. ADVISORY COMMITTEE. (a) The executive
262	262	commissioner of the Health and Human Services Commission shall
263	263	establish an advisory committee to advise the board on all policy
264	264	matters for the program.
265	265	(b) The advisory committee is composed of 22 members
266	266	appointed by the governor, lieutenant governor, or speaker of the
267	267	house of representatives as follows:
268	268	(1) the governor shall appoint:
269	269	(A) one board-certified physician;
270	270	(B) one dentist;
271	271	(C) one representative of private hospitals;
272	272	(D) one representative of public hospitals;
273	273	(E) one representative of an integrated health
274	274	care delivery system;
275	275	(F) two consumers of health care, one of whom is a
276	276	person with a disability; and
277	277	(G) one representative of a business that employs
278	278	fewer than 25 people;
279	279	(2) the lieutenant governor shall appoint:
280	280	(A) one board-certified physician;
281	281	(B) two registered nurses;
282	282	(C) one mental health care provider;
283	283	(D) one consumer of health care who is at least 65
284	284	years of age;
285	285	(E) one representative of essential community
286	286	providers; and
287	287	(F) one representative of organized labor; and
288	288	(3) the speaker of the house of representatives shall
289	289	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 this state. Appointments to the advisory
306	306	committee shall be made without regard to the race, color, sex,
307	307	religion, age, or national origin of the appointees.
308	308	(e) An advisory committee member serves a four-year term and
309	309	may be 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) An advisory 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 committee
324	324	business; and
325	325	(3) is entitled to the per diem provided by the General
326	326	Appropriations Act for attending committee meetings.
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. 1698.0063. 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. 1698.0064. CONTRACTS. (a) The board may enter into
383	383	any 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. 1698.0065. 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 Health and Human Services
424	424	Commission.
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. 1698.0066. 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. 1698.0101. ELIGIBILITY AND ENROLLMENT. (a) Every
450	450	resident is eligible and entitled to enroll as a member.
451	451	(b) A member may not be required to pay:
452	452	(1) any fee, payment, or other charge for enrolling in
453	453	the program or being a member; or
454	454	(2) any premium, copayment, coinsurance, deductible,
455	455	or any other form of cost sharing for all covered benefits.
456	456	(c) A college, university, or other institution of higher
457	457	education in this state may purchase coverage under the program for
458	458	a student, or a student's dependent, who is not a resident.
459	459	SUBCHAPTER D. BENEFITS
460	460	Sec. 1698.0151. BENEFITS. (a) Covered health care
461	461	benefits under the program include all health care services
462	462	determined to be clinically appropriate by a member's health care
463	463	provider.
464	464	(b) Covered health care benefits for a member include:
465	465	(1) inpatient and outpatient health care services and
466	466	health facility services;
467	467	(2) inpatient and outpatient professional health care
468	468	provider health care 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 Center
498	498	for Complementary and Integrative Health of the National Institutes
499	499	of 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. 1698.0152. BENEFITS OFFERED BY 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 members but may, if otherwise authorized,
535	535	offer benefits to cover health care services that are not offered to
536	536	members.
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. 1698.0201. HEALTH CARE PROVIDERS. (a) A health care
543	543	provider may participate in the program to perform health care
544	544	services in this 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 begins on
568	568	the date the member first receives health care services from a
569	569	primary care provider.
570	570	(f) A member who wants to withdraw after the initial 90-day
571	571	evaluation period must request a withdrawal under the dispute
572	572	resolution procedures established by the board and may request
573	573	assistance from the patient advocate in resolving the dispute. The
574	574	dispute must be resolved in a timely manner and may not have an
575	575	adverse effect on the care the member receives.
576	576	Sec. 1698.0202. CARE COORDINATION. (a) A member's care
577	577	coordinator shall provide care coordination to the member. A care
578	578	coordinator may employ or use the services of other individuals or
579	579	entities to assist in providing care coordination for the member
580	580	consistent with board rules, statutory requirements, and
581	581	applicable occupational regulations.
582	582	(b) Care coordination includes administrative tracking and
583	583	medical recordkeeping services for members, except as otherwise
584	584	specified for integrated health care delivery systems.
585	585	(c) Care coordination administrative tracking and medical
586	586	recordkeeping services for members may not be required to use a
587	587	certified electronic health record, meet any other requirements of
588	588	the Health Information Technology for Economic and Clinical Health
589	589	Act, enacted under the American Recovery and Reinvestment Act of
590	590	2009 (Pub. L. No. 111-5), or meet certification requirements of the
591	591	Centers for Medicare and Medicaid Services' electronic health
592	592	record incentive programs, including meaningful use requirements.
593	593	(d) A referral from a care coordinator is not required for a
594	594	member to see an eligible provider.
595	595	Sec. 1698.0203. CARE COORDINATORS. (a) A care coordinator
596	596	shall comply with all federal and state privacy laws, including:
597	597	(1) the Health Insurance Portability and
598	598	Accountability Act of 1996 (Pub. L. No. 104-191) and regulations
599	599	adopted under that Act;
600	600	(2) state law relating to the confidentiality of
601	601	medical information, including Chapter 181, Health and Safety Code;
602	602	(3) Subtitle D, Title 5; and
603	603	(4) Title 11, Business & Commerce Code.
604	604	(b) A care coordinator may be an individual or entity
605	605	approved by the program that is:
606	606	(1) a health care practitioner who is:
607	607	(A) the member's primary care provider;
608	608	(B) the member's provider of primary
609	609	gynecological care; or
610	610	(C) at the option of a member who has a chronic
611	611	condition that requires specialty care, a specialist health care
612	612	practitioner who regularly and continually provides treatment to
613	613	the member for that condition;
614	614	(2) an entity that is:
615	615	(A) a health facility;
616	616	(B) a health maintenance organization;
617	617	(C) a nursing facility or assisted living
618	618	facility under Chapter 242 or 247, Health and Safety Code, or a
619	619	program for long-term care services coverage developed by the
620	620	board;
621	621	(D) a county medical facility;
622	622	(E) a residential care facility for individuals
623	623	with chronic, life-threatening illness;
624	624	(F) an Alzheimer's day care resource center;
625	625	(G) a residential care facility for the elderly;
626	626	(H) a home health agency;
627	627	(I) a private duty nursing agency;
628	628	(J) a hospice;
629	629	(K) a pediatric day health and respite care
630	630	facility;
631	631	(L) a home care service; or
632	632	(M) a mental health care provider;
633	633	(3) a health care organization;
634	634	(4) a jointly managed trust authorized under 29 U.S.C.
635	635	Section 141 et seq. that contains a plan of benefits for employees
636	636	that is negotiated in a collective bargaining agreement governing
637	637	wages, hours, and working conditions of the employer that is
638	638	authorized under 29 U.S.C. Section 157; or
639	639	(5) a not-for-profit or governmental entity approved
640	640	by the program.
641	641	(c) Subsection (b)(4) does not preclude a trust described by
642	642	Subsection (b)(4) from becoming a care coordinator under Subsection
643	643	(b)(5) or a health care organization under Section 1698.0208.
644	644	(d) To maintain approval as a care coordinator under the
645	645	program, a care coordinator must:
646	646	(1) renew its license every three years as prescribed
647	647	by board rule; and
648	648	(2) provide to the program any data required by the
649	649	Department of State Health Services under Chapter 108, Health and
650	650	Safety Code, that would enable the board to evaluate the impact of
651	651	care coordinators on quality, outcomes, and cost of health care.
652	652	(e) An individual or entity may not be a care coordinator
653	653	unless the services included in care coordination are within the
654	654	individual's professional scope of practice or the entity's legal
655	655	authority.
656	656	Sec. 1698.0204. ENROLLMENT WITH CARE COORDINATOR. (a)
657	657	Before receiving health care services to be paid for under the
658	658	program, a member must be encouraged to enroll with a care
659	659	coordinator that agrees to provide care coordination. If a member
660	660	receives health care services before choosing a care coordinator,
661	661	the program shall assist the member, when appropriate, with
662	662	choosing a care coordinator. The member must remain enrolled with
663	663	that care coordinator until the member becomes enrolled with a
664	664	different care coordinator or ceases to be a member.
665	665	(b) A member may change care coordinators on terms at least
666	666	as permissive as those under Medicaid relating to an individual
667	667	changing primary care providers or managed care organizations.
668	668	(c) A health care provider may be reimbursed for services
669	669	only if the member is enrolled with a care coordinator at the time
670	670	the health care service is provided.
671	671	(d) A health care organization may establish rules relating
672	672	to care coordination for its members that are different from this
673	673	subchapter but otherwise consistent with this chapter and other
674	674	applicable laws.
675	675	Sec. 1698.0205. PROCEDURES AND STANDARDS FOR CARE
676	676	COORDINATION. (a) The board by rule shall develop and implement
677	677	procedures and standards for an individual or entity to be approved
678	678	as a care coordinator in the program, including procedures and
679	679	standards relating to the revocation, suspension, limitation, or
680	680	annulment of approval on a determination that the individual or
681	681	entity:
682	682	(1) is incompetent to be a care coordinator;
683	683	(2) has exhibited a course of conduct that is
684	684	inconsistent with program standards and rules;
685	685	(3) exhibits an unwillingness to comply with program
686	686	standards and rules; or
687	687	(4) is a potential threat to the public health or
688	688	safety.
689	689	(b) The procedures and standards adopted by the board must
690	690	be consistent with professional practice, licensure standards, and
691	691	rules established under the Government Code, Health and Safety
692	692	Code, Human Resources Code, Insurance Code, and Occupations Code,
693	693	as applicable.
694	694	(c) In developing and implementing standards of approval of
695	695	care coordinators for individuals receiving chronic mental health
696	696	care services, the board shall consult with the Health and Human
697	697	Services Commission.
698	698	Sec. 1698.0206. OCCUPATIONAL LAWS NOT AFFECTED. Nothing in
699	699	Section 1698.0202, 1698.0203, 1698.0204, or 1698.0205 authorizes
700	700	an individual to engage in any act in violation of Title 3,
701	701	Occupations Code.
702	702	Sec. 1698.0207. PAYMENT FOR HEALTH CARE SERVICES AND CARE
703	703	COORDINATION. (a) The board shall adopt rules related to
704	704	contracting and establishing payment methodologies for covered
705	705	health care services and care coordination provided to members
706	706	under the program by participating providers, care coordinators,
707	707	and health care organizations. A variety of different payment
708	708	methodologies may be used, including those established on a
709	709	demonstration basis. All payment rates under the program shall be
710	710	reasonable and reasonably related to the cost of efficiently
711	711	providing the health care service and ensuring an adequate and
712	712	accessible supply of health care services.
713	713	(b) Health care services provided to a member under the
714	714	program, except for care coordination, must be paid for on a
715	715	fee-for-service basis unless the board establishes another payment
716	716	methodology.
717	717	(c) Notwithstanding Subsection (b), integrated health care
718	718	delivery systems, essential community providers, and group medical
719	719	practices that provide comprehensive, coordinated services may
720	720	choose to be reimbursed on the basis of a capitated system operating
721	721	budget or a noncapitated system operating budget that covers all
722	722	costs of providing health care services.
723	723	(d) The program shall engage in good faith negotiations with
724	724	health care providers' representatives under Subchapter H,
725	725	including in relation to rates of payment for health care services,
726	726	rates of payment for prescription and nonprescription drugs, and
727	727	payment methodologies. Those negotiations shall be through a single
728	728	entity on behalf of the entire program for prescription and
729	729	nonprescription drugs.
730	730	(e) Payment for health care services established under this
731	731	chapter is considered payment in full. A participating provider may
732	732	not charge a rate in excess of the payment established under this
733	733	chapter for any health care service provided to a member under the
734	734	program and may not solicit or accept payment from any member or
735	735	third party for any health care service, except as provided under a
736	736	federal program. This section does not preclude the program from
737	737	acting as a primary or secondary payer in conjunction with another
738	738	third-party payer when permitted by a federal program.
739	739	(f) The board by rule may adopt payment methodologies for
740	740	the payment of capital-related expenses for specifically
741	741	identified capital expenditures incurred by not-for-profit or
742	742	governmental entities that are health facilities under Subtitle B,
743	743	Title 4, Health and Safety Code. Any capital-related expense
744	744	generated by a capital expenditure that requires prior approval
745	745	must have received that approval before being paid by the program.
746	746	The approval must be based on achievement of the program standards
747	747	described by Subchapter F.
748	748	(g) Payment methodologies and payment rates must include a
749	749	distinct component of reimbursement for direct and indirect
750	750	graduate medical education.
751	751	(h) The board by rule shall adopt payment methodologies and
752	752	procedures for paying for health care services provided to a member
753	753	while the member is located outside this state.
754	754	Sec. 1698.0208. HEALTH CARE ORGANIZATIONS. (a) A member
755	755	may choose to enroll with and receive program care coordination and
756	756	ancillary health care services from a health care organization.
757	757	(b) The health care organization must be a not-for-profit or
758	758	governmental entity that is approved by the board and is:
759	759	(1) a local health care system; or
760	760	(2) a community center for persons with developmental
761	761	disabilities under Chapter 534, Health and Safety Code.
762	762	(c) To maintain approval under the program, a health care
763	763	organization must:
764	764	(1) renew the approval as frequently as prescribed by
765	765	board rule; and
766	766	(2) provide to the program any data required by the
767	767	Department of State Health Services under Chapter 108, Health and
768	768	Safety Code, that would enable the board to evaluate the impact of
769	769	health care organizations on quality outcomes and cost of health
770	770	care.
771	771	Sec. 1698.0209. PROCEDURES AND STANDARDS FOR HEALTH CARE
772	772	ORGANIZATIONS. (a) The board by rule shall develop and implement
773	773	procedures and standards for an entity to be approved as a health
774	774	care organization in the program, including procedures and
775	775	standards relating to the revocation, suspension, limitation, or
776	776	annulment of approval on a determination that the entity:
777	777	(1) is incompetent to be a health care organization;
778	778	(2) has exhibited a course of conduct that is
779	779	inconsistent with program standards and rules;
780	780	(3) exhibits an unwillingness to comply with program
781	781	standards and rules; or
782	782	(4) is a potential threat to the public health or
783	783	safety.
784	784	(b) The procedures and standards adopted by the board must
785	785	be consistent with professional practice, licensure standards, and
786	786	rules established under the Government Code, Health and Safety
787	787	Code, Human Resources Code, Insurance Code, and Occupations Code,
788	788	as applicable.
789	789	(c) In developing and implementing standards of approval of
790	790	health care organizations, the board shall consult with the Health
791	791	and Human Services Commission.
792	792	Sec. 1698.0210. BEST INTEREST OF PATIENT. A health care
793	793	organization may not use health information technology or clinical
794	794	practice guidelines that limit the effective exercise of the
795	795	professional judgment of physicians and registered nurses.
796	796	Physicians and registered nurses shall be free to override health
797	797	information technology and clinical practice guidelines if, in
798	798	their professional judgment, it is in the best interest of the
799	799	patient and consistent with the patient's wishes.
800	800	SUBCHAPTER F. PROGRAM STANDARDS
801	801	Sec. 1698.0251. PROGRAM STANDARDS. (a) The board by rule
802	802	shall establish requirements and standards for the program and for
803	803	health care organizations, care coordinators, and health care
804	804	providers, consistent with this chapter and applicable
805	805	professional practice, licensure standards, and rules of health
806	806	care providers and health care professionals established under the
807	807	Government Code, Health and Safety Code, Human Resources Code,
808	808	Insurance Code, and Occupations Code, including requirements and
809	809	standards related to:
810	810	(1) the scope, quality, and accessibility of health
811	811	care services;
812	812	(2) relations between health care organizations or
813	813	health care providers and members; and
814	814	(3) relations between health care organizations and
815	815	health care providers, including credentialing and participation
816	816	in the health care organization, and terms, methods, and rates of
817	817	payment.
818	818	(b) The board by rule shall establish requirements and
819	819	standards under the program that include provisions to promote:
820	820	(1) simplification, transparency, uniformity, and
821	821	fairness in health care provider credentialing and participation in
822	822	health care organization networks, referrals, payment procedures
823	823	and rates, claims processing, and approval of health care services,
824	824	as applicable;
825	825	(2) in-person primary and preventive care, care
826	826	coordination, efficient and effective health care services,
827	827	quality assurance, and promotion of public, environmental, and
828	828	occupational health;
829	829	(3) elimination of health care disparities;
830	830	(4) nondiscrimination with respect to members and
831	831	health care providers on the basis of race, color, ancestry,
832	832	national origin, religion, citizenship, immigration status,
833	833	primary language, mental or physical disability, age, sex, gender,
834	834	sexual orientation, gender identity or expression, medical
835	835	condition, genetic information, marital status, familial status,
836	836	military or veteran status, or source of income;
837	837	(5) accessibility of care coordination, health care
838	838	organization services, and health care services, including
839	839	accessibility for people with disabilities and people with limited
840	840	ability to speak or understand English; and
841	841	(6) the provision of care coordination, health care
842	842	organization services, and health care services in a culturally
843	843	competent manner.
844	844	(c) Notwithstanding Subsection (b)(4), health care services
845	845	provided under the program must be appropriate to the member's
846	846	clinically relevant circumstances.
847	847	(d) The board by rule shall establish requirements and
848	848	standards, to the extent authorized by federal law, for replacing
849	849	and merging with the program health care services and ancillary
850	850	services currently provided by other programs, including:
851	851	(1) Medicare;
852	852	(2) the Affordable Care Act; and
853	853	(3) other federally matched public health programs.
854	854	Sec. 1698.0252. EQUAL REQUIREMENTS AND STANDARDS. Any
855	855	participating provider or care coordinator that is organized as a
856	856	for-profit entity shall meet the same requirements and standards as
857	857	entities organized as not-for-profit entities, and payments under
858	858	the program paid to for-profit entities may not be calculated to
859	859	accommodate the generation of profit, revenue for dividends, or
860	860	other return on investment or the payment of taxes that would not be
861	861	paid by a not-for-profit entity.
862	862	Sec. 1698.0253. INFORMATION REQUIRED. Each participating
863	863	provider shall furnish information as required by the Department of
864	864	State Health Services under Chapter 108, Health and Safety Code,
865	865	and permit examination of that information by the program as may be
866	866	reasonably required for purposes of reviewing accessibility and use
867	867	of health care services, quality assurance, cost containment, the
868	868	making of payments, and statistical or other studies of the
869	869	operation of the program or for protection and promotion of public,
870	870	environmental, and occupational health.
871	871	Sec. 1698.0254. CONSULTATION ON POLICY DETERMINATIONS. In
872	872	developing requirements and standards and making other policy
873	873	determinations under this subchapter, the board shall consult with
874	874	representatives of members, health care providers, care
875	875	coordinators, health care organizations, labor organizations
876	876	representing health care employees, and other interested parties.
877	877	SUBCHAPTER G. FUNDING
878	878	Sec. 1698.0301. FEDERAL HEALTH PROGRAMS AND FUNDING
879	879	GENERALLY. (a) The board shall seek any federal waiver or other
880	880	federal approval and arrangement and submit each state plan
881	881	amendment necessary to operate the program.
882	882	(b) The board shall apply to the United States secretary of
883	883	health and human services or other appropriate federal official for
884	884	any waiver of a requirement and make any other arrangement under
885	885	Medicare, any federally matched public health program, the
886	886	Affordable Care Act, and any other federal program that provides
887	887	federal money for payment for health care services necessary so
888	888	that:
889	889	(1) each member receives all benefits under the
890	890	program through the program;
891	891	(2) the state may implement this chapter; and
892	892	(3) the state receives all federal payments under the
893	893	applicable program, including money that may be provided in lieu of
894	894	premium tax credits, cost-sharing subsidies, and small business tax
895	895	credits.
896	896	(c) The state shall deposit money received under Subsection
897	897	(b)(3) in the state treasury to the credit of the fund and shall use
898	898	that money for the program and to implement this chapter.
899	899	(d) To the extent possible, the board shall negotiate
900	900	arrangements with the federal government to ensure that federal
901	901	payments are paid to the program in place of federal funding of, or
902	902	tax benefits for, federally matched public health programs or
903	903	federal health programs.
904	904	(e) The board may require members or applicants to provide
905	905	information necessary for the program to comply with any waiver or
906	906	arrangement under this chapter. Information provided by a member
907	907	to the board for the purposes of this subsection may not be used for
908	908	any other purpose.
909	909	(f) The board may take any additional actions necessary to
910	910	effectively fund implementation of the program to the extent
911	911	possible as a single-payer program consistent with this chapter.
912	912	Sec. 1698.0302. ADMINISTRATION OF MEDICARE AND FEDERALLY
913	913	MATCHED PUBLIC HEALTH PROGRAMS. (a) The board may take actions
914	914	consistent with this subchapter to enable the program to administer
915	915	Medicare in this state, and the program shall be a provider of
916	916	Medicare Part B supplemental insurance coverage and shall provide
917	917	premium assistance drug coverage under Medicare Part D for eligible
918	918	members of the program.
919	919	(b) The board may waive or modify the applicability of any
920	920	provision of this subchapter relating to any federally matched
921	921	public health program or Medicare, as necessary, to implement any
922	922	waiver or arrangement under this subchapter or to maximize the
923	923	federal benefits to the program under this subchapter, provided
924	924	that the board, in consultation with the comptroller, determines
925	925	that the waiver or modification is in the best interest of the state
926	926	and members affected by the action.
927	927	(c) The board may apply for coverage for, and enroll, any
928	928	eligible member under any federally matched public health program
929	929	or Medicare. Enrollment in a federally matched public health
930	930	program or Medicare may not cause any member to lose any health care
931	931	service provided by the federal program or Medicare or diminish any
932	932	right the member would otherwise have.
933	933	(d) Notwithstanding Subsection (c) or any other law, the
934	934	board by rule shall increase the income eligibility level, increase
935	935	or eliminate the resource test for eligibility, simplify any
936	936	procedural or documentation requirement for enrollment, and
937	937	increase the benefits for any federally matched public health
938	938	program and for any program to reduce or eliminate an individual's
939	939	coinsurance, cost-sharing, or premium obligations or increase an
940	940	individual's eligibility for any federal financial support related
941	941	to Medicare or the Affordable Care Act. The board may act under
942	942	this subsection on a finding approved by the comptroller and the
943	943	board that the action:
944	944	(1) will help increase the number of members who are:
945	945	(A) eligible for and enrolled in federally
946	946	matched public health programs; or
947	947	(B) eligible for any program to reduce or
948	948	eliminate an individual's coinsurance, cost-sharing, or premium
949	949	obligations or increase an individual's eligibility for any federal
950	950	financial support related to Medicare or the Affordable Care Act;
951	951	(2) will not diminish any individual's access to any
952	952	health care service or right the individual would otherwise have;
953	953	(3) is in the interest of the program; and
954	954	(4) does not require or has already received any
955	955	required federal waiver or approval to ensure federal financial
956	956	participation.
957	957	(e) Any action taken under Subsection (d) may not apply to
958	958	eligibility for payment for long-term care services.
959	959	(f) To enable the board to apply for coverage for and enroll
960	960	any eligible member under any federally matched public health
961	961	program or Medicare, the board may require that each member or
962	962	applicant provide the information necessary to enable the board to
963	963	determine whether the applicant is eligible for a federally matched
964	964	public health program or for Medicare, or any program or benefit
965	965	under Medicare.
966	966	(g) As a condition of continued eligibility for health care
967	967	services under the program, a member who is eligible for benefits
968	968	under Medicare must enroll in Medicare, including Parts A, B, and D.
969	969	Sec. 1698.0303. PREMIUM ASSISTANCE AND SUBSIDIES FOR
970	970	MEDICARE PART D. (a) The program shall provide premium assistance
971	971	for each member enrolling in a Medicare Part D drug coverage plan
972	972	under 42 U.S.C. Section 1395w-101 et seq., limited to the
973	973	low-income benchmark premium amount established by the Centers for
974	974	Medicare and Medicaid Services and any other amount the federal
975	975	agency establishes under its de minimis premium policy, except that
976	976	those payments made on behalf of a member enrolled in a Medicare
977	977	advantage plan may exceed the low-income benchmark premium amount
978	978	if determined to be cost effective to the program.
979	979	(b) If the board has reasonable grounds to believe that a
980	980	member may be eligible for an income-related subsidy under 42
981	981	U.S.C. Section 1395w-114, the member shall provide, and authorize
982	982	the program to obtain, any information or documentation required to
983	983	establish the member's eligibility for that subsidy. Before
984	984	requesting information or documentation from a member under this
985	985	subsection, the board shall attempt to obtain as much of the
986	986	information and documentation as possible from records that are
987	987	available to the board.
988	988	Sec. 1698.0304. PROGRAM AND BOARD DUTIES. (a) The program
989	989	shall make a reasonable effort to notify each member of the member's
990	990	obligations under this subchapter. After a reasonable effort has
991	991	been made to contact the member, the program shall notify the member
992	992	in writing that the member has 60 days to provide the required
993	993	information. If the member does not provide the required
994	994	information within the 60-day period, the program may terminate the
995	995	member's coverage under the program. Information provided by a
996	996	member to the board for the purposes of this subchapter may not be
997	997	used for any other purpose.
998	998	(b) The board shall assume responsibility for all benefits
999	999	and services paid for by the federal government with that money.
1000	1000	Sec. 1698.0305. FUND; ADMINISTRATION. (a) The healthy
1001	1001	Texas fund is a special fund in the state treasury outside the
1002	1002	general revenue fund.
1003	1003	(b) In conjunction with the enactment of the General
1004	1004	Appropriations Act, the legislature shall develop a revenue plan,
1005	1005	taking into consideration anticipated federal revenue available
1006	1006	for the program, and appropriate money for the program as
1007	1007	necessary. In developing the revenue plan, members of the
1008	1008	legislature shall consult with appropriate officials and
1009	1009	stakeholders.
1010	1010	(c) Notwithstanding any other law, money in the fund may not
1011	1011	be loaned to or borrowed by any other special fund or the general
1012	1012	revenue fund.
1013	1013	(d) The board shall establish and maintain a prudent reserve
1014	1014	in the fund.
1015	1015	(e) The board or staff of the board may not use any money
1016	1016	intended for the administrative and operational expenses of the
1017	1017	board for staff retreats, promotional giveaways, excessive
1018	1018	executive compensation, or promotion of federal or state
1019	1019	legislative or regulatory modifications.
1020	1020	(f) Notwithstanding any other law, all interest earned on
1021	1021	the money that has been deposited into the fund is retained in the
1022	1022	fund and used for purposes consistent with the fund.
1023	1023	(g) The fund consists of:
1024	1024	(1) federal payments received as a result of any
1025	1025	waiver of requirements granted or other arrangement agreed to by
1026	1026	the United States secretary of health and human services or other
1027	1027	appropriate federal official for health care programs established
1028	1028	under Medicare, any federally matched public health program, or the
1029	1029	Affordable Care Act;
1030	1030	(2) amounts paid by the Health and Human Services
1031	1031	Commission that are equivalent to the amounts that are paid on
1032	1032	behalf of residents under Medicare, any federally matched public
1033	1033	health program, or the Affordable Care Act for health benefits that
1034	1034	are equivalent to health benefits covered under the program;
1035	1035	(3) federal and state money for purposes of the
1036	1036	provision of services authorized under Title XX of the Social
1037	1037	Security Act (42 U.S.C. Section 1397 et seq.) that would otherwise
1038	1038	be covered under the program; and
1039	1039	(4) state money that would otherwise be appropriated
1040	1040	to any governmental agency, office, program, instrumentality, or
1041	1041	institution that provides health care services for services and
1042	1042	benefits covered under the program.
1043	1043	(h) Money in the fund may be used only for the purposes
1044	1044	established in this chapter.
1045	1045	SUBCHAPTER H. COLLECTIVE NEGOTIATION AND BARGAINING
1046	1046	Sec. 1698.0351. APPLICABILITY OF SUBCHAPTER. (a) This
1047	1047	subchapter applies to a health care provider that is:
1048	1048	(1) an individual who practices that profession as a
1049	1049	health care provider or as an independent contractor;
1050	1050	(2) an owner, officer, shareholder, or proprietor of a
1051	1051	health care provider; or
1052	1052	(3) an entity that employs or uses health care
1053	1053	providers to provide health care services, including a health
1054	1054	facility licensed under the Health and Safety Code.
1055	1055	(b) A health care provider licensed or otherwise certified
1056	1056	under Title 3, Occupations Code, who practices as an employee of a
1057	1057	health care provider is not a health care provider for purposes of
1058	1058	this subchapter.
1059	1059	Sec. 1698.0352. COLLECTIVE NEGOTIATION AUTHORIZED. (a)
1060	1060	Health care providers may meet and communicate for the purpose of
1061	1061	collectively negotiating with the program on any matter relating to
1062	1062	the program, including rates of payment for health care services,
1063	1063	rates of payment for prescription and nonprescription drugs, and
1064	1064	payment methodologies.
1065	1065	(b) This subchapter may not be construed to allow or
1066	1066	authorize:
1067	1067	(1) an alteration of the terms of the internal and
1068	1068	external review procedures prescribed by law;
1069	1069	(2) a strike of the program by health care providers
1070	1070	related to the collective negotiations; or
1071	1071	(3) terms or conditions that would impede the ability
1072	1072	of the program to obtain or retain accreditation by the National
1073	1073	Committee for Quality Assurance or a similar body, or to comply with
1074	1074	applicable state or federal law.
1075	1075	Sec. 1698.0353. COLLECTIVE NEGOTIATION. (a) Collective
1076	1076	negotiation rights granted by this subchapter must provide that:
1077	1077	(1) a health care provider may communicate with other
1078	1078	health care providers regarding the terms and conditions to be
1079	1079	negotiated with the program;
1080	1080	(2) a health care provider may communicate with a
1081	1081	health care providers' representative;
1082	1082	(3) a health care providers' representative is the
1083	1083	only party authorized to negotiate with the program on behalf of the
1084	1084	health care providers as a group;
1085	1085	(4) a health care provider may be bound by the terms
1086	1086	and conditions negotiated by the health care providers'
1087	1087	representative; and
1088	1088	(5) in communicating or negotiating with the health
1089	1089	care providers' representative, the program is entitled to offer
1090	1090	and provide different terms and conditions to individual competing
1091	1091	health care providers.
1092	1092	(b) This subchapter does not affect or limit:
1093	1093	(1) the right of a health care provider or group of
1094	1094	health care providers to collectively petition a governmental
1095	1095	entity for a change in a law or board rule; or
1096	1096	(2) collective action or collective bargaining on the
1097	1097	part of a health care provider with that health care provider's
1098	1098	employer or any other lawful collective action or collective
1099	1099	bargaining.
1100	1100	Sec. 1698.0354. DUTIES OF HEALTH CARE PROVIDERS'
1101	1101	REPRESENTATIVE. (a) Before engaging in collective negotiations
1102	1102	with the program on behalf of health care providers, a health care
1103	1103	providers' representative shall file with the board, in the manner
1104	1104	prescribed by the board, information identifying the
1105	1105	representative, the representative's plan of operation, and the
1106	1106	representative's procedures to ensure compliance with this
1107	1107	subchapter.
1108	1108	(b) Each person who acts as the representative of a
1109	1109	negotiating party under this subchapter shall pay a fee, as adopted
1110	1110	by board rule, to the board to act as a representative.
1111	1111	Sec. 1698.0355. PROHIBITED COLLECTIVE ACTION. (a) This
1112	1112	subchapter does not authorize competing health care providers to
1113	1113	act in concert in response to a health care providers'
1114	1114	representative's discussions or negotiations with the program,
1115	1115	except as authorized by other law.
1116	1116	(b) A health care providers' representative may not
1117	1117	negotiate any agreement that excludes, limits the participation or
1118	1118	reimbursement of, or otherwise limits the scope of services to be
1119	1119	provided by any health care provider or group of health care
1120	1120	providers with respect to the performance of services that are
1121	1121	within the health care provider's scope of practice, license,
1122	1122	registration, or certificate.
1123	1123	SECTION 2. Not later than two years after the effective date
1124	1124	of this Act, the Healthy Texas Board created by this Act shall:
1125	1125	(1) in consultation with an advisory committee
1126	1126	appointed by the chairperson of the board, including
1127	1127	representatives of consumers and potential consumers of long-term
1128	1128	care services, providers of long-term care services, members of
1129	1129	organized labor, and other interested parties, develop a proposal
1130	1130	consistent with the principles of Chapter 1698, Insurance Code, as
1131	1131	added by this Act, for providing and funding long-term care
1132	1132	services coverage by the Healthy Texas Program;
1133	1133	(2) develop a proposal for accommodating employer
1134	1134	retiree health benefits for people who have been members of the
1135	1135	Healthy Texas Program but live as retirees outside this state;
1136	1136	(3) develop a proposal for accommodating employer
1137	1137	retiree health benefits for people who earned or accrued those
1138	1138	benefits while residing in this state before the implementation of
1139	1139	the Healthy Texas Program and live as retirees outside this state;
1140	1140	and
1141	1141	(4) develop a proposal for Healthy Texas Program
1142	1142	coverage of health care services currently covered under the
1143	1143	workers' compensation system, including whether and how to continue
1144	1144	funding for those services under that system and whether and how to
1145	1145	incorporate an element of experience rating.
1146	1146	SECTION 3. (a) The Healthy Texas Board created by this Act
1147	1147	shall determine when individuals may begin enrolling in the Healthy
1148	1148	Texas Program. An implementation period begins on the date that
1149	1149	individuals may begin enrolling in the program and ends on a date
1150	1150	determined by the board. During the implementation period, the
1151	1151	Healthy Texas Program is subject to special eligibility and
1152	1152	financing provisions determined by the board until the program is
1153	1153	fully implemented.
1154	1154	(b) This Act does not prohibit a health benefit plan issuer
1155	1155	from offering any benefits during the implementation period to
1156	1156	individuals who enrolled or may enroll as members of the Healthy
1157	1157	Texas Program.
1158	1158	(c) Before full implementation of the Healthy Texas
1159	1159	Program, the Healthy Texas Board shall provide for the collection
1160	1160	and availability of data on the number of patients served by
1161	1161	hospitals and the dollar value of the care provided, at cost, for
1162	1162	the following categories:
1163	1163	(1) patients receiving charity care;
1164	1164	(2) contractual adjustments of county and indigent
1165	1165	programs, including traditional and managed care; and
1166	1166	(3) bad debts.
1167	1167	(d) Notwithstanding Section 1698.0054(b), Insurance Code,
1168	1168	as added by this Act, a Healthy Texas Board member is not required
1169	1169	to enroll as a member of the Healthy Texas Program until the
1170	1170	implementation period has ended.
1171	1171	SECTION 4. The Healthy Texas Board created by this Act shall
1172	1172	provide money from the healthy Texas fund established by Section
1173	1173	1698.0305, Insurance Code, as added by this Act, or from funds
1174	1174	otherwise appropriated for this purpose to the Texas Workforce
1175	1175	Commission for a program for retraining and assisting job
1176	1176	transition for individuals employed or previously employed in the
1177	1177	fields of health insurance, health care service plans, and other
1178	1178	third-party payments for health care or those individuals providing
1179	1179	services to health care providers to deal with third-party payers
1180	1180	for health care, whose jobs may be ending or have ended as a result
1181	1181	of the implementation of the Healthy Texas Program.
1182	1182	SECTION 5. (a) Notwithstanding any other law, Chapter
1183	1183	1698, Insurance Code, as added by this Act, may not be implemented
1184	1184	until the date the executive commissioner of the Health and Human
1185	1185	Services Commission notifies the secretary of the Texas Senate and
1186	1186	the chief clerk of the Texas House of Representatives in writing
1187	1187	that the executive commissioner has determined that the healthy
1188	1188	Texas fund has the revenue to fund the costs of implementing Chapter
1189	1189	1698.
1190	1190	(b) The Health and Human Services Commission shall publish a
1191	1191	copy of the notice required by Subsection (a) of this section on the
1192	1192	commission's Internet website.
1193	1193	SECTION 6. This Act takes effect September 1, 2021.