Texas 2021 - 87th Regular

Texas Senate Bill SCR31 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.C.R. No. 31
	1	+	By: Kolkhorst S.C.R. No. 31
	2	+	(Leach, Krause, Middleton, Schofield, Smith)
2	3
3	4
4	5		SENATE CONCURRENT RESOLUTION
5	6		WHEREAS, Plaintiffs Dorena Coleman, Curtis Jackson, and
6	7		Federico Perez, individually, (collectively referred to as
7	8		"Plaintiffs"), filed suit on August 13, 2020, against the Texas
8	9		Health and Human Services Commission, including employees in their
9	10		official capacities ("HHSC"), and sought relief both on Plaintiffs'
10	11		own behalf and on behalf of a class of similarly situated
11	12		individuals ("Medicaid HCV Class"), and filed a motion for class
12	13		certification on August 14, 2020; and
13	14		WHEREAS, Plaintiffs alleged HHSC's Prior Authorization
14	15		Criteria and Policy's use of fibrosis score as criterion for direct
15	16		action antiviral drug (DAA) coverage violated Title XIX of the
16	17		Social Security Act:
17	18		(a) By discriminating among similarly situated Medicaid
18	19		recipients on the basis of categorical restrictions that are not
19	20		based upon prevailing clinical standards, as prohibited by 42
20	21		U.S.C. § 1396a(a)(10)(B)(i) and (ii) and 42 C.F.R. § 440.240;
21	22		(b) By denying qualified Medicaid participants the
22	23		provision of necessary medical assistance and treatment coverage
23	24		with "reasonable promptness," as required by 42 U.S.C. §
24	25		1396a(a)(8);
25	26		(c) By excluding qualified Medicaid recipients from
26	27		medically necessary treatment coverage as required by 42 U.S.C. §
27	28		1396a(a)(10)(A); and
28	29		WHEREAS, Defendants denied the allegations of the Lawsuit,
29	30		denied all allegations of wrongdoing and liability, and denied any
30	31		causation of harm or damage to the Medicaid HCV Class; and
31	32		WHEREAS, The parties mediated this matter on December 1,
32	33		2020, with the Honorable Patrick Keel as mediator, and thereafter
33	34		successfully reached an agreement in principle on December 17,
34	35		2020; and
35	36		WHEREAS, The Parties have now agreed to a full settlement on
36	37		the following terms:
37	38		(a) HHSC will modify its Medicaid prior authorization (PA)
38	39		criteria to treat chronic Hepatitis C clients who have METAVIR
39	40		fibrosis scores of F2-F4 with Direct Acting Antiviral (DAA)
40	41		treatment by March 1, 2021;
41	42		(b) Between March 1, 2021, and September 1, 2021, Medicaid
42	43		enrollees with severe extrahepatic effects of chronic Hepatitis C
43	44		who have fibrosis scores other than F2-F4 will be approved for DAA
44	45		treatment on a case-by-case basis by the HHSC Chief Medical
45	46		Director or an MCO Medical Director, if they are assigned to an MCO;
46	47		(c) As of September 1, 2021, HHSC will remove all METAVIR
47	48		fibrosis score, drug screening, and specialist prescription PA
48	49		criteria requirements for DAA treatment for chronic Hepatitis C
49	50		clients, if the legislature approves the funding for HHSC's
50	51		Exceptional Item (EI); HHSC agrees that, for the period September
51	52		1, 2021, through August 31, 2023, HHSC will not reinstate these
52	53		criteria; and
53	54		WHEREAS, This Agreement is expressly conditioned upon
54	55		approval by the Office of the Attorney General of Texas, the
55	56		Governor of Texas, and the Texas Legislature; and
56	57		WHEREAS, This Agreement is expressly conditioned upon
57	58		enactment by the Texas Legislature of the EI requested by HHSC; and
58	59		WHEREAS, Section 111.003(b), Texas Civil Practice and
59	60		Remedies Code, requires a state agency to obtain legislative
60	61		approval of a settlement agreement that "commits this state to a
61	62		course of action that in reasonable probability will entail a
62	63		continuing increased expenditure of state funds over subsequent
63	64		state fiscal bienniums"; therefore, the Settlement Agreement is
64	65		expressly conditioned upon the legislature approving and
65	66		appropriating the agreed upon settlement amount; now, therefore, be
66	67		it
67	68		RESOLVED, That the 87th Legislature of the State of Texas
68	69		hereby approve the proposed Settlement Agreement.
69		-	______________________________ ______________________________
70		-	President of the Senate Speaker of the House
71		-	______________________________ ______________________________
72		-	President of the Senate Speaker of the House
73		-	I hereby certify that S.C.R. No. 31 was adopted by the Senate
74		-	on May 19, 2021, by the following vote: Yeas 31, Nays 0.
75		-	______________________________
76		-	Secretary of the Senate
77		-	I hereby certify that S.C.R. No. 31 was adopted by the House
78		-	on May 29, 2021, by the following vote: Yeas 133, Nays 0,
79		-	one present not voting.
80		-	______________________________
81		-	Chief Clerk of the House
82		-	Approved:
83		-	______________________________
84		-	Date
85		-	______________________________
86		-	Governor