2005 Texas Government Code CHAPTER 534. LOCALLY BASED MEDICAID AND OTHER RELATED HEALTH CARE INITIATIVES

GOVERNMENT CODE

CHAPTER 534. LOCALLY BASED MEDICAID AND OTHER RELATED HEALTH CARE 
INITIATIVES

SUBCHAPTER A. GENERAL PROVISIONS


	§ 534.001. LEGISLATIVE INTENT.                                              

Text of section effective until September 1, 2011
	It is the intent of the legislature that certain local 
governmental entities collaborate to the extent necessary with 
other local governmental entities and small business employers to 
provide or deliver cost-effective health care services to persons 
eligible to participate in the initiatives established under this 
chapter.

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          


	§ 534.002. DEFINITIONS.                                                     

Text of section effective until September 1, 2011
	In this chapter:                                                               
		(1)  "Local governmental entity" means:                                       
			(A)  a hospital district created and established 
under the authority of Sections 4 through 11, Article IX, Texas 
Constitution;
			(B)  a hospital authority created and established 
under Chapter 262 or 264, Health and Safety Code, that to some 
extent uses tax or other public revenue to provide health care 
services to indigent persons;
			(C)  a hospital owned and operated by a 
municipality, county, or hospital authority and created under 
Chapter 262 or 264, Health and Safety Code;
			(D)  a medical school operated by this state;                                
			(E)  a medical school that receives state funds 
under Section 61.093, Education Code, or a chiropractic school that 
receives state funds under the General Appropriations Act;
			(F)  a teaching hospital operated by The 
University of Texas System;       
			(G)  a county that provides health care services 
and assistance to indigent residents of the county under Subchapter 
B, Chapter 61, Health and Safety Code;
			(H)  a governmental entity that provides funds to 
a public hospital for the provision of health care services to 
indigent persons under Section 61.062, Health and Safety Code;
			(I)  a county with a population of more than 
400,000 that provides funds to a public hospital and that is not 
included in the boundaries of a hospital district;
			(J)  a hospital owned by a municipality and leased 
to and operated by a nonprofit hospital for a public purpose, 
subject to federal approval of matching funds from such an entity;
			(K)  a health services district created and 
established under Chapter 287, Health and Safety Code;  and
			(L)  a statewide rural health care system 
established under Chapter 20C or 845, Insurance Code.
		(2)  "Managed care organization" means a person who is 
authorized or otherwise permitted by law to arrange for or provide a 
managed care plan.
		(3)  "Managed care plan" means a plan under which a 
person undertakes to provide, arrange for, pay for, or reimburse 
any part of the cost of any health care services.  A part of the plan 
must consist of arranging for or providing health care services as 
distinguished from indemnification against the cost of those 
services on a prepaid basis through insurance or otherwise.  The 
term includes a primary care case management provider network.  The 
term does not include a plan that indemnifies a person for the cost 
of health care services through insurance.
		(4)  "Task force" means the task force on local health 
care initiatives established under Section 534.101.

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          


	§ 534.003. RULES.                                                           

Text of section effective until September 1, 2011
	(a)  The commission shall adopt rules as necessary to 
implement this chapter.
	(b)  The commission may require the Texas Department of Human 
Services or any other health and human services agency to adopt, 
with the approval of the commission, any rules that may be necessary 
to implement this chapter.

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          

SUBCHAPTER B. TASK FORCE


	§ 534.101. TASK FORCE ON LOCAL HEALTH CARE INITIATIVES.                     

Text of section effective until September 1, 2011
	(a)  The commissioner shall establish a task force on local 
health care initiatives.
	(b)  The commissioner shall appoint as members of the task 
force:            
		(1)  10 representatives of local governmental 
entities, at least seven of whom must be representatives of local 
governmental entities located in counties or municipalities with a 
population of 500,000 or more and one of whom represents the 
interests of local governmental entities in rural areas;
		(2)  two representatives of health care providers, 
including one member who represents the interests of private 
nonprofit health benefit plans;
		(3)  one representative of small business owners;                             
		(4)  one physician licensed under Subtitle B, Title 3, 
Occupations Code;  and
		(5)  one public member.                                                       
	(c)  The members of the task force serve staggered two-year 
terms with as near as possible to half of the members' terms 
expiring February 1 of each year.  The members shall draw lots at 
the first task force meeting to determine the length of each 
member's initial term and the members' terms that expire each year.
	(d)  The commissioner shall designate a member of the task 
force to serve as presiding officer.
	(e)  A member of the task force is not entitled to 
compensation for service on the task force and is not entitled to 
reimbursement for travel expenses.

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          


	§ 534.102. POWERS AND DUTIES.                                               

Text of section effective until September 1, 2011
	(a)  The task force may, in conjunction with the commission, 
develop one or both of the demonstration projects authorized under 
Subchapter C.
	(b)  The task force shall:                                                     
		(1)  advise the commission on local health care issues 
and concerns affecting local governmental entities selected to 
participate in a demonstration project developed under Subchapter 
C;
		(2)  assist the commission with the preparation of a 
report that may be required by Section 534.203;
		(3)  if one or both of the demonstration projects 
authorized under Subchapter C are established, identify 
administrative costs that the commission may incur with regard to 
the implementation of each of the demonstration projects that is 
established and develop a mechanism to provide for the 
reimbursement of those costs by the participating local 
governmental entities;  and
		(4)  perform any other duty or function prescribed by 
this chapter or other law.

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          


	§ 534.103. MEETINGS.                                                        

Text of section effective until September 1, 2011
	The task force shall meet at the call of the presiding 
officer.              

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          

SUBCHAPTER C. DEMONSTRATION PROJECTS TO PROVIDE HEALTH CARE 
COVERAGE TO LOW-INCOME PARENTS OF CHILDREN RECEIVING MEDICAID


	§ 534.201. DEMONSTRATION PROJECT TO EXTEND MEDICAID 
COVERAGE TO CERTAIN LOW-INCOME PARENTS.  

Text of section effective until September 1, 2009
	(a)  The commission and task force may jointly develop a 
locally based demonstration project to provide medical assistance 
under the state Medicaid program to an individual who:
		(1)  is the parent of a child receiving medical 
assistance under the state Medicaid program;
		(2)  has a family income that is at or below 100 percent 
of the federal poverty level;
		(3)  is not otherwise eligible for medical assistance 
under the state Medicaid program at the time the individual's 
eligibility for participation in the demonstration project is 
determined;  and
		(4)  is not covered by health insurance or another type 
of health benefit plan other than a health benefit plan 
administered by or on behalf of a local governmental entity.
	(b)  If the demonstration project is established, the 
commission and task force shall jointly:
		(1)  develop a health benefit plan operating as an 
extension of the state Medicaid program and determine the benefits 
package included in the plan, which may not include all of the 
Medicaid program benefits;
		(2)  ensure that the project is financed using money 
and any other resources made available by participating local 
governmental entities to the commission for matching purposes to 
maximize federal money for the state Medicaid program;
		(3)  ensure that each participating local governmental 
entity receives money to provide services, through the health 
benefit plan, to project participants residing in the geographical 
area served by the entity in an amount that is at least equal to the 
amount of:
			(A)  money or other resources that were provided 
for matching by the entity for purposes of the project;  and
			(B)  any corresponding federal matching money;                               
		(4)  provide participating local governmental entities 
with the option to form, with the assistance of the commission and 
task force, exclusive provider networks to provide and deliver 
health care services to project participants using a managed care 
approach;
		(5)  design the project in a manner that, to the extent 
possible, uses a local governmental entity's existing indigent 
health care delivery system and administrative structure to provide 
services through the health benefit plan to project participants;  
and
		(6)  design the project in a manner that allows, to the 
extent allowed by federal law or other federal authorization, local 
governmental entities to make determinations of eligibility and 
enroll eligible individuals in the project.
	(c)  A health benefit plan developed under this section may 
require an individual who participates in the project to make 
copayments or pay deductible amounts on a sliding scale basis.
	(d)  Local money described by Subsection (b)(2) includes tax 
or other revenue spent to provide indigent health care services to 
project participants before they were eligible to participate in 
the demonstration project.
	(e)  The manner in which a local governmental entity makes 
money available for matching purposes under Subsection (b)(2) may 
include an option for the entity to be able to certify the amount of 
money considered available instead of sending the money directly to 
the state.
	(f)  A provider network described by Subsection (b)(4) may 
include a combination of public and private health care providers.  
A local governmental entity that forms an exclusive provider 
network under a demonstration project established under this 
section may include itself as a member of the network.
	(g)  The commission may not implement a project without the 
approval of the task force.
	(h)  A local governmental entity that wants to participate in 
a project established under this section must obtain approval for 
that participation from the entity's governing body, except that a 
hospital district created under Chapter 281, Health and Safety 
Code, must instead obtain that approval from the commissioners 
court of the county in which the district is located.  A local 
governmental entity that receives permission to participate shall 
notify the commission and task force of its intention to 
participate as soon as possible after September 1, 2003.  If a 
project is implemented, the commission shall select each local 
governmental entity that makes money available for matching 
purposes under Subsection (b)(2).
	(i)  This section expires September 1, 2009.                                   

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          


	§ 534.202. DEMONSTRATION PROJECT TO OFFER HEALTH CARE 
COVERAGE TO CERTAIN LOW-INCOME WORKING PARENTS.  

Text of section effective until September 1, 2009
	(a)  The commission and task force may jointly develop a 
demonstration project in which local governmental entities partner 
with employers to offer health benefits coverage to employees who:
		(1)  are the parents of a child receiving medical 
assistance under the state Medicaid program or of a child enrolled 
in the state child health plan program under Chapter 62, Health and 
Safety Code;
		(2)  have family incomes that are at or below 200 
percent of the federal poverty level;  and
		(3)  are not covered by health insurance or another 
type of health benefit plan other than a health benefit plan that is 
administered by or on behalf of a local governmental entity.
	(b)  The components of a demonstration project developed 
under this section must include:
		(1)  the development of a health benefit plan to 
provide coverage for health care services to project participants 
that:
			(A)  requires plan coverage to be purchased using 
a combination of local, federal, participant, and employer 
contributions;
			(B)  provides a benefits package that is similar 
to benefits packages offered by employer-sponsored health benefit 
plans but may not cover all of the state Medicaid program benefits;  
and
			(C)  to the extent possible eliminates coverage 
for duplicative or extraordinary services;  and
		(2)  the development of sliding scale premiums for 
certain project participants, including the manner in which the 
premium is paid.
	(c)  If the demonstration project is established, the 
commission and task force shall jointly:
		(1)  review similar initiatives in other states;                              
		(2)  ensure that the project is:                                              
			(A)  designed and administered in a manner that 
qualifies for federal funding;  and
			(B)  financed using a combination of local, 
federal, and private money;  and
		(3)  provide a participating local governmental entity 
with the option to contract with a managed care organization to 
administer the health benefit plan in the geographical area served 
by the local governmental entity.
	(d)  In developing a health benefit plan under Subsection 
(b)(1), the commissioner and task force must include provisions 
intended to discourage:
		(1)  employers and other persons from electing to 
discontinue offering coverage for individuals under employee or 
other group health benefit plans;  and
		(2)  individuals with access to adequate health benefit 
plan coverage, other than coverage under the health benefit plan 
developed under Subsection (b)(1), from electing not to obtain or 
to discontinue that coverage.
	(e)  A health benefit plan developed under Subsection (b)(1) 
is not subject to a law that requires coverage or the offer of 
coverage of a health care service or benefit.
	(f)  The commission and task force shall jointly determine 
the amounts each person described by Subsection (b)(1)(A) must 
contribute to the total cost of a health benefit plan developed for 
a demonstration project established under this section, except that 
the commission may not require a project participant whose income 
is not greater than 100 percent of the federal poverty level to pay 
a premium.
	(g)  Local money described by Subsection (c)(2)(B) includes 
tax or other revenue spent to provide indigent health care services 
to project participants before they were eligible to participate in 
the project and any other resources made available to the 
commission under this section for federal matching purposes.
	(h)  The commission may not implement a project without the 
approval of the task force.
	(i)  A local governmental entity that wants to participate in 
a project established under this section must obtain approval for 
that participation from the entity's governing body, except that a 
hospital district created under Chapter 281, Health and Safety 
Code, must instead obtain that approval from the commissioners 
court of the county in which the district is located.  If a project 
is implemented, the commission and task force shall select each 
local governmental entity that makes local money described by 
Subsections (c)(2)(B) and (g) available for the project.  The 
commission shall provide information as requested regarding the 
project to any local governmental entity that is interested in 
participating in the project.
	(j)  At the request of the commissioner, the Texas Department 
of Insurance shall provide any necessary assistance with the 
development of the health benefit plan under Subsection (b)(1).
	(k)  This section expires September 1, 2009.                                   

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          


	§ 534.203. REPORTS.                                                         

Text of section effective until September 1, 2009
	(a)  If a demonstration project is established under Section 
534.201 or 534.202, the commission, not later than December 1 of 
each even-numbered year, shall submit a report to the legislature 
regarding the operation and cost-effectiveness of each project 
established under those sections.
	(b)  The report for the demonstration project established 
under Section 534.202 must include a recommendation regarding the 
feasibility of expanding the project statewide.
	(c)  This section expires September 1, 2009.                                   

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.          

SUBCHAPTER D. MISCELLANEOUS PROVISIONS


	§ 534.301. EXPIRATION.                                                      

Text of section effective until September 1, 2011
	This chapter expires September 1, 2011.                                        

Added by Acts 2003, 78th Leg., ch. 1139, § 1, eff. Sept. 1, 2003.