HBA-MPM C.S.H.B. 1864 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1864 By: Capelo Public Health 4/26/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Community health advisors, also known as promotoras, have assisted public health providers in serving individuals and communities in the border region for quite some time. Promotoras provide such services to health centers as assisting in daily clinical activities such as case conferences, patient education, referrals to other health and social services, and volunteer coordination. In the community, promotoras may conduct needs assessments, distribute surveys to identify barriers to health care delivery, and make home visits for patient education and follow-up. Additionally, through their bilingual skills, they help families talk to their health care providers. By 1998, at least 30 promotora projects operated in the Texas border region. The level of training promotoras receive varies, however, as the state has no uniform optional training program for these individuals. A uniform training program would enable a health care provider to know what training a promotora has received. C.S.H.B. 1864 establishes a temporary committee to study issues related to the development of a uniform Optional Promotora Outreach Program, which includes a standard curriculum for volunteers, a certification program for paid promotoras, the information a promotora should make available to the community, and a method to evaluate the success of the program. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of public health in SECTION 1.05 and to the Texas Board of Health in SECTION 2.01 (Section 46.003, Health and Safety Code) of this bill. SECTION BY SECTION ANALYSIS ARTICLE 1. PROMOTORA PROGRAM DEVELOPMENT COMMITTEE SECTION 1.01. PURPOSE. Sets forth the purpose of this article. SECTION 1.02. DEFINITIONS. Defines for the purpose of this article, the following terms: "CHIP," "commissioner," "committee," "department," "local pilot project," "Medicaid managed care organization," and "promotora" or "community health worker." SECTION 1.03. COMMITTEE. Requires the Texas Department of Health (TDH) to establish the Promotora Program Development Committee (committee) to study the development of a framework for a promotora development program (program) and to advise TDH, the governor, and the legislature regarding its findings and recommendations. Provides that the committee is composed of 15 members, and sets forth its composition. Makes Chapter 2110 (State Agency Advisory Committees), Government Code, inapplicable to the committee, except that Section 2110.005 (Agency-Developed Statement of Purpose; Reporting Requirements) does apply. Provides that a committee member is not entitled to compensation for committee service. Provides that reasonable and necessary expenses incurred in performing duties as a committee member by a member who is an officer or state government employee are reimbursed as expenses incurred in the performance of that member's duties as a state officer or employee. Entitles the two committee members currently serving as promotoras to reimbursement for reasonable travel expenses as provided by the General Appropriations Act and out of appropriations to the department. Provides that other committee members are not entitled to reimbursement expenses. Requires the department to provide staff support to the committee. Requires the committee to meet at the call of the presiding officer, at the call of the commissioner of public health (commissioner), and as provided by procedural rules or schedules adopted by the committee. Requires the committee to elect its presiding officer from among its members. SECTION 1.04. RESPONSIBILITIES OF COMMITTEE. Requires the activities of the committee to include review and assessment of programs operating in this state; studies regarding curriculum for promotoras and certification options; assessments to evaluate program success; creation, oversight, and advising of local pilot projects; and evaluation seeking a federal waiver to include the program under the state Medicaid program. Requires the committee, in conducting its activities, to consult with nationally recognized experts in the field of lay community health outreach workers. Requires the committee to submit a report to the department, the governor, and the presiding officer of each house of the legislature that includes its findings and recommendations for the program no later than December 31, 2000. SECTION 1.05. MEDICAID/CHIP PROMOTORA PILOT PROJECTS. (a) Authorizes the committee to establish a series of neighborhood-based peer health outreach and education pilot projects to demonstrate the feasibility and benefits of employing promotoras to assist beneficiaries of the Medicaid managed care and CHIP programs. (b) Requires certain activities of the promotoras to be included in any local pilot projects. (c) Authorizes the commissioner, with the advice of the committee and subject to the availability of appropriations that may be used for this purpose, to provide grants to local pilot projects in no more than five areas in the state to provide partial support for the operation of the pilot program in that area. (d) Authorizes the commissioner, with the advice of the committee, to adopt rules relating to an application for grands under this section and to the use of funds granted to local pilot projects under this section. (e) Authorizes the commissioner, subject to requirements of federal law or regulations, to authorize a local pilot project to obtain certain information from certain state entities and to use the information to conduct the local pilot project in the area. (f) Provides that information that may be obtained from a local pilot project under Subsection (e) of this section is limited to the information that the commissioner with the advice of the committee determines necessary to achieve the purposes of the local pilot project. Authorizes this information to include certain facts with respect to a Medicaid recipient. (g) Authorizes confidential information obtained by a local pilot project to be used by the project only for the purposes for which it was obtained and prohibits it from being released by the project to any person other than the subject of the information. Authorizes the commissioner to adopt rules imposing additional restrictions on the use of the information. SECTION 1.06. FUNDING. Requires the department to pay for costs of all activities authorized or required under this article out of money appropriated to the department that may be used for that purpose. SECTION 1.06. EXPIRATION. Provides that the committee is abolished and this Act expires September 1, 2001. ARTICLE 2. VOLUNTARY TRAINING AND REGULATION PROGRAM SECTION 2.01. AMENDMENT. Amends Subtitle B, Title 2, Health and Safety Code, by adding Chapter 46, as follows: CHAPTER 46. TRAINING AND REGULATION OF PROMOTORAS Sec. 46.001. DEFINITION. Defines "promotora" for purposes of this chapter. Sec. 46.002. PROMOTORA TRAINING PROGRAM. Requires TDH to establish and operate a program designed to train and educate persons acting as promotoras and requires TDH in establishing this program to use to the extent possible as a resource, the uniform curriculum for training and educating promotoras developed by the Health Education Training Centers Alliance of Texas. Provides that participation in a training and education program established under this section is voluntary. Sec. 46.003. CERTIFICATION PROGRAM FOR PROMOTORAS. Requires TDH to establish and operate a certification program for promotoras and in establishing the program, requires the Texas Board of Health (board) to adopt rules providing minimum standards and guidelines, including participation in the training and education program under Section 46.002, for issuance of a certificate to a person under this section. Prohibits receipt of a certificate from being a requirement for a person to act as a promotora. SECTION 2.02. PROGRAM ESTABLISHMENT; ADOPTION OF RULES. Requires TDH to establish the promotora training and certification training program required by Chapter 46, Health and Safety Code, as added by this article, no later than January 1, 2000. Requires the board to adopt rules under Chapter 46, Health and Safety Code, as added by this article, no later than December 1, 1999. ARTICLE 3. EFFECTIVE DATE; EMERGENCY SECTION 3.01. Effective date: September 1, 1999. SECTION 3.02. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1864 modifies the original bill as follows: The substitute modifies the caption from "relating to the study and development of the Optional Promotora Outreach Program, under which community volunteers provide public health and sanitation services" to "relating to the study and development of outreach and education programs for promotoras or community health workers under which community residents provide public health education services." Furthermore, the substitute creates Article 1 (Promotora Program Development Committee). SECTION 1.01 of the substitute is redesignated from SECTION 1 of the original and makes modifications with respect to the purpose of the promotora program development committee (committee). SECTION 1.02 of the substitute is redesignated from proposed SECTION 2 of the original and adds the following additional definitions for the purpose of this Article: "CHIP," "commissioner," "local pilot project," "Medicaid managed care organization," and "community health care worker." SECTION 1.03 of the substitute is redesignated from proposed SECTION 3 of the original and provides that the committee is composed of 15, rather than 12, members, and otherwise modifies the composition of the committee. The substitute adds new Subsection (g), which requires the committee to elect its presiding officer from among its members. (Note: in setting forth the composition of the committee, the original provided that the representative of Texas Tech University serves as presiding officer.) SECTION 1.04 of the substitute is redesignated from SECTION 4 of the original and requires the committee to carry out certain activities, rather than requiring the committee to develop a framework for the program which includes at minimum a development of certain curriculae, programs, standardized information, and evaluation methods with respect to promotoras. Requires the committee to submit a report to certain state entities and individuals no later than December 31, 2000, rather than November 1, 2000, regarding its findings and recommendations for the program. Makes conforming and nonsubstantive changes. The substitute adds new SECTION 1.05 (Medicaid/CHIP Promotora Pilot Projects). For a complete analysis of that new section, please see the Section-by-Section Analysis in this document. SECTION 1.06 is redesignated from SECTION 5 of the original, and requires Texas Department of Health (TDH) to pay for the costs of all activities authorized or required under this section, rather than the committee's activities, out of money appropriated to TDH for that purpose. SECTION 1.07 is redesignated from SECTION 6 of the original. Provides that the committee is abolished and this article, rather than Act, expires September 1, 2001, rather than December 31, 2000. The substitute adds new Article 2 (Voluntary Training and Regulation Program). SECTION 2.01 of the substitute amends Subtitle B, Title 2, Health and Safety Code, to add Chapter 46 (Training and Regulation of Promotoras), while SECTION 2.02 sets deadlines for the establishment of the promotora training and certification program and the adoption of rules by the Texas Board of Health. For a complete analysis of these new sections, please see the Section-by-Section Analysis in this document. SECTIONS 3.01 and 3.02 are redesignated from SECTIONS 7 and 8 of the original.