HBA-NRS S.B. 1152 77(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 1152 By: Van de Putte Public Health 5/18/2001 Engrossed BACKGROUND AND PURPOSE Federal legislation is anticipated to authorize the granting of federal money to assist states in providing prescription drug plans. Senate Bill 1152 establishes the Tex Rx plan to provide prescription drug benefits to eligible individuals and outlines eligibility guidelines and enrollment duties of the Texas Department of Health. 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 (Sections 65.051, 65.058, and 65.102, Health and Safety Code) of this bill. ANALYSIS Senate Bill 1152 amends the Health and Safety Code to require the Texas Department of Health (department) to develop and, subject to available funds, implement a Tex Rx plan (plan) providing prescription drug benefits for eligible individuals. The bill requires the Texas Board of Health (board) to make policy for the plan, including policy related to eligibility for coverage under the plan and to prescription drug benefits provided under the plan. The bill requires the board to adopt rules as necessary to implement the plan and to consider any requirements imposed under a federal program that provides federal matching money for prescription drug benefits (Sec. 65.051). The bill authorizes the department to consolidate or coordinate the administration of the plan with other similar programs (Sec. 65.052). Unless prohibited by the federal program providing matching money for prescription drug benefits, the bill requires the department to obtain prescription drug manufacturer rebates for the benefit of enrollees in the plan and authorizes money obtained from the rebates to be appropriated only for the administration and operation of the plan (Sec. 65.053). The bill authorizes the department to enter into contracts relating to the purchase and distribution of prescription drugs under the plan. For contracts under the plan, the bill requires the board to retain policy-making authority, to procure contracts through a competitive procurement process, to monitor the person with whom the department contracts, to require the person with whom the department contracts to comply with provisions relating to pharmacies, to monitor the quality of services delivered to enrollees, and to provide payment under the contracts (Sec. 65.054). The bill sets forth provisions for the administration of enrollment under the plan (Sec. 65.055). The bill authorizes the department to conduct a community outreach and education campaign to provide information relating to the availability of the plan (Sec. 65.056). The bill authorizes the board to appoint regional advisory committees to provide recommendations on the implementation and operation of the plan (Sec. 65.057). The bill requires the board to adopt and implement rules for the prevention and detection of fraud in the plan. The bill authorizes the exclusion of an individual who commits fraud from the plan (Sec. 65.058). The bill provides that an individual is eligible to participate in the plan if the individual is a resident of this state and is not eligible for medical assistance under the state Medicaid program, is eligible to participate in the Medicare program, is not covered and has not been covered by a Medicare supplement policy that provides benefits for prescription drugs, and has a net family income that is at or below 200 percent of the federal poverty level (Sec. 65.101). The bill requires the board by rule to authorize the enrollment of individuals who, at any time, are covered by a Medicare supplement policy that provides prescription drug benefits and who become unable to continue to pay premiums for the policy or to pay applicable costsharing amounts (Sec. 65.102). The bill requires the department to adopt an application form and application procedures for requesting enrollment in the plan (Sec. 65.103). The bill requires the department to develop eligibility screening and enrollment procedures for the plan and provides that both screening and enrollment must be completed not later than the 30th day after the date the individual submits a complete application (Sec. 65.104). The bill requires the plan to provide benefits for prescription drug benefits as required by any federal program that provides federal matching money for prescription drug benefits. The bill authorizes the department to consider the benefits provided under the Medicaid vendor drug program (Sec. 65.151). The bill authorizes the department to require an enrollee to pay a copayment or similar charge for prescription drugs provided under the plan (Sec. 65.152). The bill requires the department to determine the terms and conditions with which a pharmacy must comply to participate in the plan (Sec. 65.201). The bill requires the department to determine reimbursement rates for participating pharmacies under the plan (Sec. 65.202). The bill prohibits the department, and any person with whom the department contracts, from varying the amount of an enrollee copayment or similar charge based on the source from which the prescription drugs are dispensed or the method of distribution of the prescription drugs (Sec. 65.203). The bill requires the department, or any person with whom the department contracts, to reimburse pharmacies for providing medication therapy management services to patients (Sec. 65.204). The bill requires the department to develop a preliminary plan for the implementation of the Tex Rx plan. The bill prohibits the department from implementing the plan until state and federal matching money becomes available. The bill requires the department to monitor federal legislation authorizing the granting of federal money for similar plans and requires the department to determine the actions required to implement the plan in coordination with any federal legislation that is enacted. The bill requires the department to report its determinations to the governor, the lieutenant governor, the speaker of the house of representatives, the Health and Human Services Commission, and the Legislative Budget Board (SECTION 3). The bill provides that the plan does not establish an entitlement to assistance in obtaining prescription drug benefits (Sec. 65.003). EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001.