HBA-NMO H.B. 1398 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1398
By: Coleman
Public Health
3/29/1999
Introduced




BACKGROUND AND PURPOSE 

In 1985, the 69th Texas Legislature enacted the Indigent Health Care and
Treatment Act  to address the problem of medical indigence in Texas and to
define the basic indigent health care responsibilities of the counties,
public hospitals, and hospital districts. 

In 1997, a joint interim charge was issued to the House Committees on
Public Health and County Affairs to review the law and make
recommendations.  The committees' interim report concluded that changes in
health care delivery, health care financing, and changes in the population
of this state, left some situations inadequately addressed. 

H.B. 1398 authorizes the Texas Department of Health (TDH) to administer and
enforce the Indigent Health Care and Treatment Act, widens the scope of
mandatory and optional indigent health care services, amends eligibility
requirements, modifies state financial assistance to counties, and
establishes reporting requirements.  This bill also requires TDH to study
the current threshold for state assistance, and requires the commissioner
of health and human services to establish a regional health care delivery
system pilot program in a region of the state.    

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the Texas Board of Health in SECTION
1.02 (Section 61.0055, Health and Safety Code) and SECTION 1.11 (Section
61.0395, Health and Safety Code); and to the commissioner of health and
human services in SECTION 4.05 of this bill. 

SECTION BY SECTION ANALYSIS

ARTICLE 1.  DELIVERY OF INDIGENT HEALTH CARE BY COUNTIES, 
PUBLIC HOSPITALS, AND HOSPITAL DISTRICTS

SECTION 1.01.  Amends Section 61.002, Health and Safety Code, to delete the
definition of "AFDC."  Makes conforming changes. 

SECTION 1.02.  Amends Subchapter A, Chapter 61, Health and Safety Code, by
adding Section 61.0055, as follows: 

Sec. 61.0055.  ADMINISTRATION AND ENFORCEMENT; RULES.  Requires the Texas
Department of Health (TDH) to administer and enforce this chapter (Indigent
Health Care and Treatment Act) and authorizes  the Texas Board of Health
(board) to adopt rules as necessary to administer and enforce this chapter. 

SECTION 1.03.  Amends Sections 61.006 and 61.007, Health and Safety Code,
as follows: 

Sec. 61.006.  STANDARDS AND PROCEDURES.  (a) Requires TDH to establish
minimum eligibility, rather than eligibility, standards for counties to use
in determining eligibility under this chapter. 

 (b) Prohibits the minimum eligibility standards from being more
restrictive than the eligibility standards used by the Texas Department of
Human Services (DHS) to determine eligibility in the Temporary Assistance
for Needy Families (TANF)-Medicaid, rather than AFDC-Medicaid, program.
Makes conforming changes. 

(c) Requires TDH to define the services and establish the payment standards
for the categories of services listed in Section 61.0285 (Optional Health
Care Services), Health and Safety Code, in addition to Section 61.028(a)
(relating to mandatory health care services), Health and Safety Code.
Authorizes TDH to consider DHS rules relating to TANF-Medicaid program.
Makes conforming changes. 

(d) Authorizes TDH to establish application, documentation, and
verification procedures that are different from and less restrictive than
the procedures used to determine eligibility in the TANF-Medicaid program.
Deletes language relating to the simplification of standards to provide
efficient county administration.  Makes conforming changes. 

(e) Makes conforming changes.

(f) Requires TDH to ensure that each person who is entitled to receive
federal Social Security Disability Income payments but who is ineligible
for Medicare because of a waiting period applicable under federal law will
be eligible for assistance under Subchapter B (County Responsibility for
Persons Not Residing in an Area Served by a Public Hospital or Hospital
District) during the period the person is ineligible for Medicare.
Provides that this subsection applies without regard to whether the
individual would otherwise meet the basic income and resources requirements
for the TANFMedicaid program. 

(g) Makes conforming changes.

(h) Makes conforming changes.

(i) Makes conforming changes.

Sec. 61.007.  INFORMATION PROVIDED BY APPLICANT.  Makes conforming changes.

SECTION 1.04.  Amends Section 61.023(b), Health and Safety Code, to
authorize a county, in addition to using a less restrictive standard of
eligibility for residents than prescribed by Subsection (a), to credit the
services provided to all persons who are eligible residents under that
standard toward eligibility for state assistance under this subchapter. 

SECTION 1.06.  Amends Section 61.028, Health and Safety Code, to require a
county to provide primary and preventive services designed to meet the
needs of the community, in addition to other mandatory health care
services.  Makes conforming changes. 

SECTION 1.07.  Amends Subchapter B, Chapter 61, Health and Safety Code, by
adding Sections 61.0285 and 61.0286, as follows: 

Sec. 61.0285.  OPTIONAL HEALTH CARE SERVICES.  Authorizes a county, in
accordance with TDH rules adopted under 61.006, Health and Safety Code, to
provide certain other medically necessary services or supplies that the
county determines to be costeffective, in addition to mandatory services
provided under Section 61.028, Health and Safety Code.  Authorizes the
county, if the services are approved by TDH under Section 61.006, Health
and Safety Code, to credit the services toward eligibility for state
assistance under this subchapter.  Authorizes a county to provide health
care services that are not specified in this section, or specified services
without TDH approval, but prohibits the county from crediting those
services toward eligibility for state assistance. 

Sec. 61.0286.  PREMIUM PAYMENTS FOR HEALTH BENEFIT PLAN COVERAGE.
Authorizes a county to credit a payment for the purchase of insurance or
other health benefit  plan coverage made  by the county on behalf of an
eligible resident under Section 157.006 (Payments for Certain Health
Insurance Coverage), Local Government Code, or Section 61.029(a) (relating
to the provision of health care services),  Health and Safety Code, toward
eligibility for state assistance under this subchapter if the county
determines that the purchase of the coverage is cost-effective.  Authorizes
a county that elects to provide health benefit plan coverage under this
section to require an eligible resident to contribute to the premium cost,
on an income-sliding scale, in accordance with Section 61.005 (Contribution
Toward Cost of Assistance), Health and Safety Code. 

SECTION 1.08.  Amends Section 61.034(a), Health and Safety Code, to make
conforming changes. 

SECTION 1.09.  Amends Section 61.036(b), Health and Safety Code, to make
conforming changes. 

SECTION 1.10.  Amends Sections 61.037, 61.038, and 61.039, Health and
Safety Code, to make conforming changes. 

SECTION 1.11.  Amends Subchapter B, Chapter 61, Health and Safety Code, by
adding Section 61.0395, as follows: 

Sec. 61.0395.  ADDITIONAL STATE ASSISTANCE FOR OUT-OF-COUNTY TERTIARY CARE.
(a) Requires TDH, in addition to care distributed in Section 61.038
(Distribution of Assistance Funds), Health and Safety Code, to distribute
assistance to a county that is otherwise eligible for state assistance
under this subchapter and that provides a significant amount of tertiary
care to eligible residents in a facility located outside of the boundaries
of the county 
   
(b) Requires the board to adopt rules governing the determination of
whether a county is eligible for additional state assistance under this
section and the allocation of money appropriated for the purposes of this
section. 

SECTION 1.12.  Amends Sections 61.041(a) and (b), Health and Safety Code,
to require TDH to establish monthly reporting requirements for all counties
required to provide indigent health care under this chapter, including
counties seeking state assistance under this chapter and establish
procedures necessary to determine if a county is eligible for state
assistance.  Makes conforming changes. 

SECTION 1.13.  Amends Subchapter B, Chapter 61, Health and Safety Code, by
adding Section 61.0415, as follows: 

Sec. 61.0415.  PERFORMANCE STANDARDS FOR PRIMARY AND PREVENTATIVE CARE.
Requires TDH, in consultation with the Legislative Budget Board, to develop
objective performance standards to measure the level of primary and
preventive services provided by a county and establish performance goals
for these services.  Authorizes TDH, to the extent that money appropriated
for state assistance under this subchapter is available for this purpose,
to provide grants to counties that meet or exceed the established
performance goals. 

SECTION 1.14.  Amends Section 61.054(a), Health and Safety Code, to require
a public hospital to provide the mandatory health care, rather than
inpatient and outpatient hospital, services a county is required to
provide.  Makes conforming changes. 

SECTION 1.15.  Amends Section 61.055, Health and Safety Code, to require a
hospital district to provide the mandatory health care services a county is
required to provide under Section 61.028, Health and Safety Code, together
with any other services required under the Texas Constitution and the
statute creating the district. 

SECTION 1.16.  Section 157.006, Local Government Code, as follows:

Sec. 157.006.  New Title:  PAYMENTS FOR CERTAIN HEALTH BENEFIT PLAN
COVERAGE.  Makes conforming changes. 

SECTION 1.17.  Amends Section 531.204(b), Government Code, to provide that
the report of the Texas Integrated Enrollment Services (TIES) Legislative
Oversight Committee must include an analysis of the feasibility of
including indigent health care programs provided by counties, public
hospitals, and hospital districts in the TIES, a schedule for inclusion of
these programs, and a statement of how TIES may be structured to address
the wide variation in information systems used by counties, public
hospitals, and hospital districts. 

SECTION 1.18.  Makes application of this Act prospective to January 1, 2000.

ARTICLE 2. FEDERAL AUTHORIZATION FOR STATE
MEDICAID PROGRAM

SECTION 2.01.  FEDERAL AUTHORIZATION.  Sets forth legislative intent.

ARTICLE 3.  THRESHOLD FOR STATE ASSISTANCE TO COUNTIES

SECTION 3.01.  STUDY.  Requires TDH to study the threshold for eligibility
for state assistance to a county established under Section 61.037 (County
Eligibility for State Assistance), Health and Safety Code, and develop a
threshold to replace the threshold established under that section that is
stated as a formula that reflects a county's fiscal capacity,  health care
resources, and demographics. 

SECTION 3.02.  WORK GROUP.  Requires TDH, in developing the eligibility
threshold, to consult with the Legislative Budget Board, the comptroller,
and the legislative committees of the house of representatives and senate
that have legislative oversight over TDH.  Requires TDH to form a work
group composed of representatives of the those entities and authorizes TDH
to request the cooperation of other persons. 

SECTION 3.03.  REPORT.  Requires TDH, not later than December 1, 2000, to
submit a written report of the study conducted under this article to the
governor, lieutenant governor, and the speaker of the house of
representatives.  Provides that the report must include the recommendations
of the work group with the proposed eligibility threshold. 

SECTION 3.04.  EXPIRATION.  Provides that this article expires August 31,
2001.   

ARTICLE 4.  PILOT PROGRAM FOR REGIONAL HEALTH
CARE DELIVERY SYSTEM

SECTION 4.01.  DEFINITIONS.  Defines "commissioner," "fund," "hospital
district," "pilot program," "public hospital," and "regional advisory
committee."   
 
SECTION 4.02.  PILOT PROGRAM.  Requires the commissioner of health and
human services (commissioner), not later than January 1, 2000, to establish
a regional health care delivery system pilot program (pilot program) in one
region of this state.  Provides that the pilot program must be established
in a region for which a regional advisory committee has been appointed.
Prohibits the commissioner from establishing the pilot program in a region
unless the governing body of each public hospital, hospital district, and
county in the region approves its establishment.  Prohibits a county
located in the region selected for the pilot program from receiving state
assistance under Chapter 61, Health and Safety Code, during the pilot
program.   

SECTION 4.03.  REGIONAL HEALTH CARE DELIVERY SYSTEM TRUST FUND.  Provides
that a regional health care system trust fund (fund) is a trust fund with
the comptroller. Provides that the fund is composed of money contributed to
the fund under this article.  Provides that the fund is not a part of the
general funds of this state.  Authorizes that the money in the fund be used
only to provide health care services through a regional health care
delivery system.  Sets forth the operating procedures of the fund. 

SECTION 4.04.  REGIONAL HEALTH CARE DELIVERY SYSTEM.  Requires the regional
advisory committee for the region participating in the pilot program to
develop a regional health care delivery system (system).  Provides that the
system must provide at a minimum the mandatory health care services
required by Section 61.028, Health and Safety Code, in each public
hospital, hospital district, and a county participating in the pilot
program.  Provides that the system, in each public hospital, hospital
district, and county, must provide comparable services to those provided in
the preceding calendar year in that respective entity.  Requires the
commissioner, on approval of the system by the commissioner, and in
consultation with the regional advisory committee, to implement the system
in the region. 

SECTION 4.05.  RULES.  Authorizes the commissioner to adopt rules as
necessary to implement the pilot program. 

SECTION 4.06.  DELEGATION OF POWER OR DUTIES.  Authorizes the commissioner
to delegate any power or duty of the commissioner under this article to TDH
or to the commissioner of public health. 

SECTION 4.07.  REPORT.  Requires the commissioner, not later than January
1, 2001, to submit a written report relating to the pilot program to the
governor, lieutenant governor, and the speaker of the house of
representatives.  Sets forth the required composition of the report. 

SECTION 4.08.  EXPIRATION; TERMINATION OF PILOT PROGRAM.  Provides that
this section expires and the pilot program is terminated August 31, 2001. 

ARTICLE 5.  EFFECTIVE DATE; EMERGENCY

SECTION 5.01.  Effective date: September 1, 1999.

SECTION 5.02.  Emergency clause.