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  By: Zerwas H.B. No. 3791
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  rel
  ating to the creation of a "Texas" solution to issues related to
  Medicaid, including flexibility in the administration of the
  Medicaid program, tailored to the needs of the state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The legislature finds that:
         a)  Our current Texas Medicaid program has reached an
  unsustainable capacity;
         b)  Texas stands to gain coverage for a significant number of
  now uninsured residents through any healthcare expansion; and
         c)  The current Texas network of hospital and physician
  providers cannot endure an expansion of patient need without
  significant reform;
         d)  It is in the best interest of this state that the
  Legislature and the Texas Health and Human Services Commission
  negotiate a plan that considers the particular needs of Texas, our
  economy, and unique population.
         SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02105 to read as follows:
         Sec. 531.02105.  FLEXIBILITY FROM FEDERAL REQUIREMENTS. (a)
  The commission shall negotiate with the United States secretary of
  health and human services, the federal Centers for Medicare and
  Medicaid Services, and other appropriate persons for flexibility to
  adjust the operation of the Medicaid program without the necessity
  of receiving federal approval for all changes to the program.  Any
  agreement reached must identify broad categories of:
               (1)  program changes that may be made without the need
  for additional federal approval; and
               (2)  program changes that require additional federal
  approval;
         (b)  In reaching an agreement, the commission shall ensure
  that any agreement:
               (1)  allows the state flexibility from federal
  requirements to develop a tailor insurance product for low-income
  adults;
               (2)  allows any product to leverage private markets by
  building on a managed care model and maximizing premium assistance
  where cost effective to the state;
               (3)  allow the product to prioritize personal
  responsibility by meaningful cost sharing requirements;
               (4)  benefits Texas taxpayers by providing appropriate
  health care coverage, encourages appropriate health care
  utilization in low-cost settings, provides meaningful tax relief at
  the local level, and frees up general revenue to support other state
  priorities.
         (c)  An agreement under this section may be limited in
  duration and may be contingent on the continued funding obligations
  of the federal government.
         SECTION 3.  Subtitle I, Title 4, Government Code, is amended
  by adding Chapter 539 to read as follows:
  CHAPTER 539.  ALTERNATIVE MEDICAID EXPANSION PROGRAMS
         Sec. 539.001.  FEDERAL AUTHORIZATION FOR ALTERNATIVE
  MEDICAID EXPANSION PROGRAMS. In addition to the commission's
  ability to negotiate under Section 531,02105, The commission shall
  actively negotiate with the United States secretary of health and
  human services, the federal Centers for Medicare and Medicaid
  Services, and other appropriate persons for federal authorization
  for the state to operate the component of the state Medicaid program
  for providing program benefits to the Medicaid expansion population
  under an alternative Medicaid expansion plan, including a block
  grant funding system or state plan amendment.
         Sec. 539.002.  MINIMUM REQUIREMENTS OF FEDERAL
  AUTHORIZATION. Federal authorization obtained under Section
  539.001 must allow for providing state Medicaid program benefits to
  recipients in the Medicaid expansion population under the same
  terms and conditions as an agreement under Section 531.02105
         Sec. 539.003.  IMPLEMENTATION OF ALTERNATIVE MEDICAID
  EXPANSION PLAN. If the commission receives the authorization
  described by Section 539.002, the commission shall develop and
  provide any appropriate state Medicaid program.
         SECTION 4.  The Health and Human Services Commission shall
  actively develop a proposal for the authorization from the
  appropriate federal entity as required by Section 531.02105 and
  Chapter 539, Government Code, as added by this Act.  As soon as
  possible after the effective date of this Act, the Health and Human
  Services Commission shall request and actively pursue obtaining the
  authorization from the appropriate federal entity.
         SECTION 5.  (a)  The Health and Human Services Commission,
  the Texas Department of Insurance, or the commission in conjunction
  with the department, shall negotiate with the appropriate federal
  entity for authorization to develop any appropriate alternative
  Medicaid expansion plan, including a state health benefit exchange.  
  The negotiated authorization must allow the state health benefit
  exchange to be flexible, patient-friendly, tailored to the needs of
  the state, and be similar to the health benefit exchange described
  in the Patients' Choice Act, S.B. 516, 111th Congress (2009), or
  H.R. 2520, 111th Congress (2009).
         (b)  If the appropriate federal entity authorizes an
  alternative Medicaid expansion plan, including a state health
  benefit exchange described in Subsection (a) of this section, the
  Health and Human Services Commission, the Texas Department of
  Insurance, or the commission in conjunction with the department,
  shall develop and implement the health benefit exchange.
         SECTION 6.  Not later than September 1, 2013, the Speaker of
  the House and the Lieutenant Governor shall each appoint a chair and
  four additional members of their respective houses to advise the
  Health and Human Services Commission and the Texas Department of
  Insurance on negotiations with the federal government regarding
  federal authorization for the state to operate the component of the
  state Medicaid program for providing program benefits to the
  Medicaid expansion population under an alternative Medicaid
  expansion plan, including a block grant funding system or state
  plan amendment.
         SECTION 7.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2013.