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  S.B. No. 10
 
 
 
 
AN ACT
  relating to the operation and financing of the medical assistance
  program and other programs to provide health care benefits and
  services to persons in this state; providing penalties.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02192 to read as follows:
         Sec. 531.02192.  FEDERALLY QUALIFIED HEALTH CENTER AND RURAL
  HEALTH CLINIC SERVICES. (a)  In this section:
               (1)  "Federally qualified health center" has the
  meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
               (2)  "Federally qualified health center services" has
  the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
               (3)  "Rural health clinic" and "rural health clinic
  services" have the meanings assigned by 42 U.S.C. Section
  1396d(l)(1).
         (b)  Notwithstanding any provision of this chapter, Chapter
  32, Human Resources Code, or any other law, the commission shall:
               (1)  promote Medicaid recipient access to federally
  qualified health center services or rural health clinic services;
  and
               (2)  ensure that payment for federally qualified health
  center services or rural health clinic services is in accordance
  with 42 U.S.C. Section 1396a(bb).
  SECTION 2.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02413 to read as follows:
         Sec. 531.02413.  BILLING COORDINATION SYSTEM.  (a)  If
  cost-effective and feasible, the commission shall, on or before
  March 1, 2008, contract through an existing procurement process for
  the implementation of an acute care Medicaid billing coordination
  system for the fee-for-service and primary care case management
  delivery models that will, upon entry in the claims system,
  identify within 24 hours whether another entity has primary
  responsibility for paying the claim and submit the claim to the
  entity the system determines is the primary payor.  The system may
  not increase Medicaid claims payment error rates.
         (b)  If cost-effective, the executive commissioner shall
  adopt rules for the purpose of enabling the system to identify an
  entity with primary responsibility for paying a claim and establish
  reporting requirements for any entity that may have a contractual
  responsibility to pay for the types of acute care services provided
  under the Medicaid program.
         (c)  An entity that holds a permit, license, or certificate
  of authority issued by a regulatory agency of the state must allow
  the contractor under Subsection (a) access to databases to allow
  the contractor to carry out the purposes of this section, subject to
  the contractor's contract with the commission and rules adopted
  under this section, and is subject to an administrative penalty or
  other sanction as provided by the law applicable to the permit,
  license, or certificate of authority for a violation by the entity
  of a rule adopted under this section.
         (d)  After September 1, 2008, no public funds shall be
  expended on entities not in compliance with this section unless a
  memorandum of understanding is entered into between the entity and
  the executive commissioner.
         (e)  Information obtained under this section is
  confidential.  The contractor may use the information only for the
  purposes authorized under this section.  A person commits an
  offense if the person knowingly uses information obtained under
  this section for any purpose not authorized under this section.  An
  offense under this subsection is a Class B misdemeanor and all other
  penalties may apply.
         SECTION 3.  (a)  Subchapter B, Chapter 531, Government Code,
  is amended by adding Section 531.02414 to read as follows:
         Sec. 531.02414.  ADMINISTRATION AND OPERATION OF MEDICAL
  TRANSPORTATION PROGRAM. (a)  In this section, "medical
  transportation program" means the program that provides
  nonemergency transportation services to and from covered health
  care services, based on medical necessity, to recipients under the
  Medicaid program, the children with special health care needs
  program, and the transportation for indigent cancer patients
  program, who have no other means of transportation.
         (b)  Notwithstanding any other law, the commission shall
  directly supervise the administration and operation of the medical
  transportation program.
         (c)  Notwithstanding any other law, the commission may not
  delegate the commission's duty to supervise the medical
  transportation program to any other person, including through a
  contract with the Texas Department of Transportation for the
  department to assume any of the commission's responsibilities
  relating to the provision of services through that program.
         (d)  The commission may contract with a public
  transportation provider, as defined by Section 461.002,
  Transportation Code, a private transportation provider, or a
  regional transportation broker for the provision of public
  transportation services, as defined by Section 461.002,
  Transportation Code, under the medical transportation program.
         (b)  Subchapter A, Chapter 531, Government Code, is amended
  by adding Section 531.0057 to read as follows:
         Sec. 531.0057.  MEDICAL TRANSPORTATION SERVICES.  (a)  The
  commission shall provide medical transportation services for
  clients of eligible health and human services programs.
         (b)  The commission may contract with any public or private
  transportation provider or with any regional transportation broker
  for the provision of public transportation services.
         SECTION 4.  (a)  Subchapter B, Chapter 531, Government Code,
  is amended by adding Sections 531.094, 531.0941, 531.097, and
  531.0971 to read as follows:
         Sec. 531.094.  PILOT PROGRAM AND OTHER PROGRAMS TO PROMOTE
  HEALTHY LIFESTYLES. (a)  The commission shall develop and
  implement a pilot program in one region of this state under which
  Medicaid recipients are provided positive incentives to lead
  healthy lifestyles, including through participating in certain
  health-related programs or engaging in certain health-conscious
  behaviors, thereby resulting in better health outcomes for those
  recipients.
         (b)  Except as provided by Subsection (c), in implementing
  the pilot program, the commission may provide:
               (1)  expanded health care benefits or value-added
  services for Medicaid recipients who participate in certain
  programs, such as specified weight loss or smoking cessation
  programs;
               (2)  individual health rewards accounts that allow
  Medicaid recipients who follow certain disease management
  protocols to receive credits in the accounts that may be exchanged
  for health-related items specified by the commission that are not
  covered by Medicaid; and
               (3)  any other positive incentive the commission
  determines would promote healthy lifestyles and improve health
  outcomes for Medicaid recipients.
         (c)  The commission shall consider similar incentive
  programs implemented in other states to determine the most
  cost-effective measures to implement in the pilot program under
  this section.
         (d)  Not later than December 1, 2010, the commission shall
  submit a report to the legislature that:
               (1)  describes the operation of the pilot program;
               (2)  analyzes the effect of the incentives provided
  under the pilot program on the health of program participants; and
               (3)  makes recommendations regarding the continuation
  or expansion of the pilot program.
         (e)  In addition to developing and implementing the pilot
  program under this section, the commission may, if feasible and
  cost-effective, develop and implement an additional incentive
  program to encourage Medicaid recipients who are younger than 21
  years of age to make timely health care visits under the early and
  periodic screening, diagnosis, and treatment program. The
  commission shall provide incentives under the program for managed
  care organizations contracting with the commission under Chapter
  533 and Medicaid providers to encourage those organizations and
  providers to support the delivery and documentation of timely and
  complete health care screenings under the early and periodic
  screening, diagnosis, and treatment program.
         (f)  This section expires September 1, 2011.
         Sec. 531.0941.  MEDICAID HEALTH SAVINGS ACCOUNT PILOT
  PROGRAM. (a)  If the commission determines that it is
  cost-effective and feasible, the commission shall develop and
  implement a Medicaid health savings account pilot program that is
  consistent with federal law to:
               (1)  encourage health care cost awareness and
  sensitivity by adult recipients; and
               (2)  promote appropriate utilization of Medicaid
  services by adult recipients.
         (b)  If the commission implements the pilot program, the
  commission may only include adult recipients as participants in the
  program.
         (c)  If the commission implements the pilot program, the
  commission shall ensure that:
               (1)  participation in the pilot program is voluntary;
  and
               (2)  a recipient who participates in the pilot program
  may, at the recipient's option and subject to Subsection (d),
  discontinue participation in the program and resume receiving
  benefits and services under the traditional Medicaid delivery
  model.
         (d)  A recipient who chooses to discontinue participation in
  the pilot program and resume receiving benefits and services under
  the traditional Medicaid delivery model before completion of the
  health savings account enrollment period forfeits any funds
  remaining in the recipient's health savings account.
         Sec. 531.097.  TAILORED BENEFIT PACKAGES FOR CERTAIN
  CATEGORIES OF THE MEDICAID POPULATION.  (a)  The executive
  commissioner may seek a waiver under Section 1115 of the federal
  Social Security Act (42 U.S.C. Section 1315) to develop and,
  subject to Subsection (c), implement tailored benefit packages
  designed to:
               (1)  provide Medicaid benefits that are customized to
  meet the health care needs of recipients within defined categories
  of the Medicaid population through a defined system of care;
               (2)  improve health outcomes for those recipients;
               (3)  improve those recipients' access to services;
               (4)  achieve cost containment and efficiency; and
               (5)  reduce the administrative complexity of
  delivering Medicaid benefits.
         (b)  The commission:
               (1)  shall develop a tailored benefit package that is
  customized to meet the health care needs of Medicaid recipients who
  are children with special health care needs, subject to approval of
  the waiver described by Subsection (a); and
               (2)  may develop tailored benefit packages that are
  customized to meet the health care needs of other categories of
  Medicaid recipients.
         (c)  If the commission develops tailored benefit packages
  under Subsection (b)(2), the commission shall submit a report to
  the standing committees of the senate and house of representatives
  having primary jurisdiction over the Medicaid program that
  specifies, in detail, the categories of Medicaid recipients to
  which each of those packages will apply and the services available
  under each package. The commission may not implement a package
  developed under Subsection (b)(2) before September 1, 2009.
         (d)  Except as otherwise provided by this section and subject
  to the terms of the waiver authorized by this section, the
  commission has broad discretion to develop the tailored benefit
  packages under this section and determine the respective categories
  of Medicaid recipients to which the packages apply in a manner that
  preserves recipients' access to necessary services and is
  consistent with federal requirements.
         (e)  Each tailored benefit package developed under this
  section must include:
               (1)  a basic set of benefits that are provided under all
  tailored benefit packages; and
               (2)  to the extent applicable to the category of
  Medicaid recipients to which the package applies:
                     (A)  a set of benefits customized to meet the
  health care needs of recipients in that category; and
                     (B)  services to integrate the management of a
  recipient's acute and long-term care needs, to the extent feasible.
         (f)  In addition to the benefits required by Subsection (e),
  a tailored benefit package developed under this section that
  applies to Medicaid recipients who are children must provide at
  least the services required by federal law under the early and
  periodic screening, diagnosis, and treatment program.
         (g)  A tailored benefit package developed under this section
  may include any service available under the state Medicaid plan or
  under any federal Medicaid waiver, including any preventive health
  or wellness service.
         (g-1)  A tailored benefit package developed under this
  section must increase the state's flexibility with respect to the
  state's use of Medicaid funding and may not reduce the benefits
  available under the Medicaid state plan to any Medicaid recipient
  population.
         (h)  In developing the tailored benefit packages, the
  commission shall consider similar benefit packages established in
  other states as a guide.
         (i)  The executive commissioner, by rule, shall define each
  category of recipients to which a tailored benefit package applies
  and a mechanism for appropriately placing recipients in specific
  categories.  Recipient categories must include children with
  special health care needs and may include:
               (1)  persons with disabilities or special health needs;
               (2)  elderly persons;
               (3)  children without special health care needs; and
               (4)  working-age parents and caretaker relatives.
         (j)  This section does not apply to a tailored benefit
  package or similar package of benefits if, before September 1,
  2007:
               (1)  a federal waiver was requested to implement the
  package of benefits;
               (2)  the package of benefits is being developed, as
  directed by the legislature; or
               (3)  the package of benefits has been implemented.
         Sec. 531.0971.  TAILORED BENEFIT PACKAGES FOR NON-MEDICAID
  POPULATIONS.  (a)  The commission shall identify state or federal
  non-Medicaid programs that provide health care services to persons
  whose health care needs could be met by providing customized
  benefits through a system of care that is used under a Medicaid
  tailored benefit package implemented under Section 531.097.
         (b)  If the commission determines that it is feasible and to
  the extent permitted by federal and state law, the commission
  shall:
               (1)  provide the health care services for persons
  identified under Subsection (a) through the applicable Medicaid
  tailored benefit package; and
               (2)  if appropriate or necessary to provide the
  services as required by Subdivision (1), develop and implement a
  system of blended funding methodologies to provide the services in
  that manner.
         (b)  Not later than September 1, 2008, the Health and Human
  Services Commission shall implement the pilot program under Section
  531.094, Government Code, as added by this section.
         SECTION 5.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.0972 to read as follows:
         Sec. 531.0972.  PILOT PROGRAM TO PREVENT THE SPREAD OF
  CERTAIN INFECTIOUS OR COMMUNICABLE DISEASES. The commission may
  provide guidance to the local health authority of Bexar County in
  establishing a pilot program funded by the county to prevent the
  spread of HIV, hepatitis B, hepatitis C, and other infectious and
  communicable diseases. The program may include a disease control
  program that provides for the anonymous exchange of used hypodermic
  needles and syringes.
         SECTION 6.  (a)  Subchapter C, Chapter 531, Government Code,
  is amended by adding Section 531.1112 to read as follows:
         Sec. 531.1112.  STUDY CONCERNING INCREASED USE OF TECHNOLOGY
  TO STRENGTHEN FRAUD DETECTION AND DETERRENCE; IMPLEMENTATION.  
  (a)  The commission and the commission's office of inspector
  general shall jointly study the feasibility of increasing the use
  of technology to strengthen the detection and deterrence of fraud
  in the state Medicaid program.  The study must include the
  determination of the feasibility of using technology to verify a
  person's citizenship and eligibility for coverage.
         (b)  The commission shall implement any methods the
  commission and the commission's office of inspector general
  determine are effective at strengthening fraud detection and
  deterrence.
         (b)  Not later than December 1, 2008, the Health and Human
  Services Commission shall submit to the legislature a report
  detailing the findings of the study required by Section 531.1112,
  Government Code, as added by this section.  The report must include
  a description of any method described by Subsection (b), Section
  531.1112, Government Code, as added by this section, that the
  commission has implemented or intends to implement.
         SECTION 7.  (a)  Chapter 531, Government Code, is amended by
  adding Subchapter N to read as follows:
  SUBCHAPTER N. TEXAS HEALTH OPPORTUNITY POOL TRUST FUND
         Sec. 531.501.  DEFINITION.  In this subchapter, "fund" means
  the Texas health opportunity pool trust fund established under
  Section 531.503.
         Sec. 531.502.  DIRECTION TO OBTAIN FEDERAL WAIVER. (a)  The
  executive commissioner may seek a waiver under Section 1115 of the
  federal Social Security Act (42 U.S.C. Section 1315) to the state
  Medicaid plan to allow the commission to more efficiently and
  effectively use federal money paid to this state under various
  programs to defray costs associated with providing uncompensated
  health care in this state by using that federal money, appropriated
  state money to the extent necessary, and any other money described
  by this section for purposes consistent with this subchapter.
         (b)  The executive commissioner may include the following
  federal money in the waiver:
               (1)  all money provided under the disproportionate
  share hospitals and upper payment limit supplemental payment
  programs;
               (2)  money provided by the federal government in lieu
  of some or all of the payments under those programs;
               (3)  any combination of funds authorized to be pooled
  by Subdivisions (1) and (2); and
               (4)  any other money available for that purpose,
  including federal money and money identified under Subsection (c).
         (c)  The commission shall seek to optimize federal funding
  by:
               (1)  identifying health care related state and local
  funds and program expenditures that, before September 1, 2007, are
  not being matched with federal money; and
               (2)  exploring the feasibility of:
                     (A)  certifying or otherwise using those funds and
  expenditures as state expenditures for which this state may receive
  federal matching money; and
                     (B)  depositing federal matching money received
  as provided by Paragraph (A) with other federal money deposited as
  provided by Section 531.504, or substituting that federal matching
  money for federal money that otherwise would be received under the
  disproportionate share hospitals and upper payment limit
  supplemental payment programs as a match for local funds received
  by this state through intergovernmental transfers.
         (d)  The terms of a waiver approved under this section must:
               (1)  include safeguards to ensure that the total amount
  of federal money provided under the disproportionate share
  hospitals and upper payment limit supplemental payment programs
  that is deposited as provided by Section 531.504 is, for a
  particular state fiscal year, at least equal to the greater of the
  annualized amount provided to this state under those supplemental
  payment programs during state fiscal year 2007, excluding amounts
  provided during that state fiscal year that are retroactive
  payments, or the state fiscal years during which the waiver is in
  effect; and
               (2)  allow for the development by this state of a
  methodology for allocating money in the fund to:
                     (A)  offset, in part, the uncompensated health
  care costs incurred by hospitals;
                     (B)  reduce the number of persons in this state
  who do not have health benefits coverage; and
                     (C)  maintain and enhance the community public
  health infrastructure provided by hospitals.
         (e)  In a waiver under this section, the executive
  commissioner shall seek to:
               (1)  obtain maximum flexibility with respect to using
  the money in the fund for purposes consistent with this subchapter;
               (2)  include an annual adjustment to the aggregate caps
  under the upper payment limit supplemental payment program to
  account for inflation, population growth, and other appropriate
  demographic factors that affect the ability of residents of this
  state to obtain health benefits coverage;
               (3)  ensure, for the term of the waiver, that the
  aggregate caps under the upper payment limit supplemental payment
  program for each of the three classes of hospitals are not less than
  the aggregate caps that applied during state fiscal year 2007; and
               (4)  to the extent allowed by federal law, including
  federal regulations, and federal waiver authority, preserve the
  federal supplemental payment program payments made to hospitals,
  the state match with respect to which is funded by
  intergovernmental transfers or certified public expenditures that
  are used to optimize Medicaid payments to safety net providers for
  uncompensated care, and preserve allocation methods for those
  payments, unless the need for the payments is revised through
  measures that reduce the Medicaid shortfall or uncompensated care
  costs.
         (f)  The executive commissioner shall seek broad-based
  stakeholder input in the development of the waiver under this
  section and shall provide information to stakeholders regarding the
  terms and components of the waiver for which the executive
  commissioner seeks federal approval.
         (g)  The executive commissioner shall seek the advice of the
  Legislative Budget Board before finalizing the terms and conditions
  of the negotiated waiver.
         Sec. 531.503.  ESTABLISHMENT OF TEXAS HEALTH OPPORTUNITY
  POOL TRUST FUND. Subject to approval of the waiver authorized by
  Section 531.502, the Texas health opportunity pool trust fund is
  created as a trust fund outside the state treasury to be held by the
  comptroller and administered by the commission as trustee on behalf
  of residents of this state who do not have private health benefits
  coverage and health care providers providing uncompensated care to
  those persons. The commission may make expenditures of money in the
  fund only for purposes consistent with this subchapter and the
  terms of the waiver authorized by Section 531.502.
         Sec. 531.504.  DEPOSITS TO FUND. (a)  The comptroller shall
  deposit in the fund:
               (1)  all federal money provided to this state under the
  disproportionate share hospitals supplemental payment program and
  the hospital upper payment limit supplemental payment program,
  other than money provided under those programs to state-owned and
  operated hospitals, and all other non-supplemental payment program
  federal money provided to this state that is included in the waiver
  authorized by Section 531.502; and
               (2)  state money appropriated to the fund.
         (b)  The commission and comptroller may accept gifts,
  grants, and donations from any source for purposes consistent with
  this subchapter and the terms of the waiver. The comptroller shall
  deposit a gift, grant, or donation made for those purposes in the
  fund.
         Sec. 531.505.  USE OF FUND IN GENERAL; RULES FOR ALLOCATION.
  (a)  Except as otherwise provided by the terms of a waiver
  authorized by Section 531.502, money in the fund may be used:
               (1)  subject to Section 531.506, to provide
  reimbursements to health care providers that:
                     (A)  are based on the providers' costs related to
  providing uncompensated care; and
                     (B)  compensate the providers for at least a
  portion of those costs;
               (2)  to reduce the number of persons in this state who
  do not have health benefits coverage;
               (3)  to reduce the need for uncompensated health care
  provided by hospitals in this state; and
               (4)  for any other purpose specified by this subchapter
  or the waiver.
         (b)  On approval of the waiver, the executive commissioner
  shall:
               (1)  seek input from a broad base of stakeholder
  representatives on the development of rules with respect to, and
  the administration of, the fund; and
               (2)  by rule develop a methodology for allocating money
  in the fund that is consistent with the terms of the waiver.
         Sec. 531.506.  REIMBURSEMENTS FOR UNCOMPENSATED HEALTH CARE
  COSTS. (a)  Except as otherwise provided by the terms of a waiver
  authorized by Section 531.502 and subject to Subsections (b) and
  (c), money in the fund may be allocated to hospitals in this state
  and political subdivisions of this state to defray the costs of
  providing uncompensated health care in this state.
         (b)  To be eligible for money from the fund under this
  section, a hospital or political subdivision must use a portion of
  the money to implement strategies that will reduce the need for
  uncompensated inpatient and outpatient care, including care
  provided in a hospital emergency room. Strategies that may be
  implemented by a hospital or political subdivision, as applicable,
  include:
               (1)  fostering improved access for patients to primary
  care systems or other programs that offer those patients medical
  homes, including the following programs:
                     (A)  regional or local health care programs;
                     (B)  programs to provide premium subsidies for
  health benefits coverage; and
                     (C)  other programs to increase access to health
  benefits coverage; and
               (2)  creating health care systems efficiencies, such as
  using electronic medical records systems.
         (c)  The allocation methodology adopted by the executive
  commissioner under Section 531.505(b) must specify the percentage
  of the money from the fund allocated to a hospital or political
  subdivision that the hospital or political subdivision must use for
  strategies described by Subsection (b).
         Sec. 531.507.  INCREASING ACCESS TO HEALTH BENEFITS
  COVERAGE. (a)  Except as otherwise provided by the terms of a
  waiver authorized by Section 531.502, money in the fund that is
  available to reduce the number of persons in this state who do not
  have health benefits coverage or to reduce the need for
  uncompensated health care provided by hospitals in this state may
  be used for purposes relating to increasing access to health
  benefits coverage for low-income persons, including:
               (1)  providing premium payment assistance to those
  persons through a premium payment assistance program developed
  under this section;
               (2)  making contributions to health savings accounts
  for those persons; and
               (3)  providing other financial assistance to those
  persons through alternate mechanisms established by hospitals in
  this state or political subdivisions of this state that meet
  certain criteria, as specified by the commission.
         (b)  The commission and the Texas Department of Insurance
  shall jointly develop a premium payment assistance program designed
  to assist persons described by Subsection (a) in obtaining and
  maintaining health benefits coverage.  The program may provide
  assistance in the form of payments for all or part of the premiums
  for that coverage.  In developing the program, the executive
  commissioner shall adopt rules establishing:
               (1)  eligibility criteria for the program;
               (2)  the amount of premium payment assistance that will
  be provided under the program;
               (3)  the process by which that assistance will be paid;
  and
               (4)  the mechanism for measuring and reporting the
  number of persons who obtained health insurance or other health
  benefits coverage as a result of the program.
         (c)  The commission shall implement the premium payment
  assistance program developed under Subsection (b), subject to
  availability of money in the fund for that purpose.
         Sec. 531.508.  INFRASTRUCTURE IMPROVEMENTS.  (a)  Except as
  otherwise provided by the terms of a waiver authorized by Section
  531.502 and subject to Subsection (c), money in the fund may be used
  for purposes related to developing and implementing initiatives to
  improve the infrastructure of local provider networks that provide
  services to Medicaid recipients and low-income uninsured persons in
  this state.
         (b)  Infrastructure improvements under this section may
  include developing and implementing a system for maintaining
  medical records in an electronic format.
         (c)  Not more than 10 percent of the total amount of the money
  in the fund used in a state fiscal year for purposes other than
  providing reimbursements to hospitals for uncompensated health
  care may be used for infrastructure improvements described by
  Subsection (b).
         (b)  If the executive commissioner of the Health and Human
  Services Commission obtains federal approval for a waiver under
  Section 531.502, Government Code, as added by this section, the
  executive commissioner shall submit a report to the Legislative
  Budget Board that outlines the components and terms of that waiver
  as soon as possible after federal approval is granted.
         SECTION 8.  (a)  Chapter 531, Government Code, is amended by
  adding Subchapter O to read as follows:
  SUBCHAPTER O. UNCOMPENSATED HOSPITAL CARE
         Sec. 531.551.  UNCOMPENSATED HOSPITAL CARE REPORTING AND
  ANALYSIS. (a)  The executive commissioner shall adopt rules
  providing for:
               (1)  a standard definition of "uncompensated hospital
  care";
               (2)  a methodology to be used by hospitals in this state
  to compute the cost of that care that incorporates the standard set
  of adjustments described by Section 531.552(g)(4); and
               (3)  procedures to be used by those hospitals to report
  the cost of that care to the commission and to analyze that cost.
         (b)  The rules adopted by the executive commissioner under
  Subsection (a)(3) may provide for procedures by which the
  commission may periodically verify the completeness and accuracy of
  the information reported by hospitals.
         (c)  The commission shall notify the attorney general of a
  hospital's failure to report the cost of uncompensated care on or
  before the date the report was due in accordance with rules adopted
  under Subsection (a)(3). On receipt of the notice, the attorney
  general shall impose an administrative penalty on the hospital in
  the amount of $1,000 for each day after the date the report was due
  that the hospital has not submitted the report, not to exceed
  $10,000.
         (d)  If the commission determines through the procedures
  adopted under Subsection (b) that a hospital submitted a report
  with incomplete or inaccurate information, the commission shall
  notify the hospital of the specific information the hospital must
  submit and prescribe a date by which the hospital must provide that
  information. If the hospital fails to submit the specified
  information on or before the date prescribed by the commission, the
  commission shall notify the attorney general of that failure. On
  receipt of the notice, the attorney general shall impose an
  administrative penalty on the hospital in an amount not to exceed
  $10,000. In determining the amount of the penalty to be imposed,
  the attorney general shall consider:
               (1)  the seriousness of the violation;
               (2)  whether the hospital had previously committed a
  violation; and
               (3)  the amount necessary to deter the hospital from
  committing future violations.
         (e)  A report by the commission to the attorney general under
  Subsection (c) or (d) must state the facts on which the commission
  based its determination that the hospital failed to submit a report
  or failed to completely and accurately report information, as
  applicable.
         (f)  The attorney general shall give written notice of the
  commission's report to the hospital alleged to have failed to
  comply with a requirement. The notice must include a brief summary
  of the alleged violation, a statement of the amount of the
  administrative penalty to be imposed, and a statement of the
  hospital's right to a hearing on the alleged violation, the amount
  of the penalty, or both.
         (g)  Not later than the 20th day after the date the notice is
  sent under Subsection (f), the hospital must make a written request
  for a hearing or remit the amount of the administrative penalty to
  the attorney general. Failure to timely request a hearing or remit
  the amount of the administrative penalty results in a waiver of the
  right to a hearing under this section. If the hospital timely
  requests a hearing, the attorney general shall conduct the hearing
  in accordance with Chapter 2001, Government Code. If the hearing
  results in a finding that a violation has occurred, the attorney
  general shall:
               (1)  provide to the hospital written notice of:
                     (A)  the findings established at the hearing; and
                     (B)  the amount of the penalty; and
               (2)  enter an order requiring the hospital to pay the
  amount of the penalty.
         (h)  Not later than the 30th day after the date the hospital
  receives the order entered by the attorney general under Subsection
  (g), the hospital shall:
               (1)  pay the amount of the administrative penalty;
               (2)  remit the amount of the penalty to the attorney
  general for deposit in an escrow account and file a petition for
  judicial review contesting the occurrence of the violation, the
  amount of the penalty, or both; or
               (3)  without paying the amount of the penalty, file a
  petition for judicial review contesting the occurrence of the
  violation, the amount of the penalty, or both and file with the
  court a sworn affidavit stating that the hospital is financially
  unable to pay the amount of the penalty.
         (i)  The attorney general's order is subject to judicial
  review as a contested case under Chapter 2001, Government Code.
         (j)  If the hospital paid the penalty and on review the court
  does not sustain the occurrence of the violation or finds that the
  amount of the administrative penalty should be reduced, the
  attorney general shall remit the appropriate amount to the hospital
  not later than the 30th day after the date the court's judgment
  becomes final.
         (k)  If the court sustains the occurrence of the violation:
               (1)  the court:
                     (A)  shall order the hospital to pay the amount of
  the administrative penalty; and
                     (B)  may award to the attorney general the
  attorney's fees and court costs incurred by the attorney general in
  defending the action; and
               (2)  the attorney general shall remit the amount of the
  penalty to the comptroller for deposit in the general revenue fund.
         (l)  If the hospital does not pay the amount of the
  administrative penalty after the attorney general's order becomes
  final for all purposes, the attorney general may enforce the
  penalty as provided by law for legal judgments.
         Sec. 531.552.  WORK GROUP ON UNCOMPENSATED HOSPITAL CARE.  
  (a)  In this section, "work group" means the work group on
  uncompensated hospital care.
         (b)  The executive commissioner shall establish the work
  group on uncompensated hospital care to assist the executive
  commissioner in developing rules required by Section 531.551 by
  performing the functions described by Subsection (g).
         (c)  The executive commissioner shall determine the number
  of members of the work group. The executive commissioner shall
  ensure that the work group includes representatives from the office
  of the attorney general and the hospital industry. A member of the
  work group serves at the will of the executive commissioner.
         (d)  The executive commissioner shall designate a member of
  the work group to serve as presiding officer. The members of the
  work group shall elect any other necessary officers.
         (e)  The work group shall meet at the call of the executive
  commissioner.
         (f)  A member of the work group may not receive compensation
  for serving on the work group but is entitled to reimbursement for
  travel expenses incurred by the member while conducting the
  business of the work group as provided by the General
  Appropriations Act.
         (g)  The work group shall study and advise the executive
  commissioner in:
               (1)  identifying the number of different reports
  required to be submitted to the state that address uncompensated
  hospital care, care for low-income uninsured persons in this state,
  or both;
               (2)  standardizing the definitions used to determine
  uncompensated hospital care for purposes of those reports;
               (3)  improving the tracking of hospital charges, costs,
  and adjustments as those charges, costs, and adjustments relate to
  identifying uncompensated hospital care and maintaining a
  hospital's tax-exempt status;
               (4)  developing and applying a standard set of
  adjustments to a hospital's initial computation of the cost of
  uncompensated hospital care that account for all funding streams
  that:
                     (A)  are not patient-specific; and
                     (B)  are used to offset the hospital's initially
  computed amount of uncompensated care;
               (5)  developing a standard and comprehensive center for
  data analysis and reporting with respect to uncompensated hospital
  care; and
               (6)  analyzing the effect of the standardization of the
  definition of uncompensated hospital care and the computation of
  its cost, as determined in accordance with the rules adopted by the
  executive commissioner, on the laws of this state, and analyzing
  potential legislation to incorporate the changes made by the
  standardization.
         (b)  The executive commissioner of the Health and Human
  Services Commission shall:
               (1)  establish the work group on uncompensated hospital
  care required by Section 531.552, Government Code, as added by this
  section, not later than October 1, 2007; and
               (2)  adopt the rules required by Section 531.551,
  Government Code, as added by this section, not later than January 1,
  2009.
         (c)  The executive commissioner of the Health and Human
  Services Commission shall review the methodology used under the
  Medicaid disproportionate share hospitals supplemental payment
  program to compute low-income utilization costs to ensure that the
  Medicaid disproportionate share methodology is consistent with the
  standardized adjustments to uncompensated care costs described by
  Subdivision (4), Subsection (g), Section 531.552, Government Code,
  as added by this section, and adopted by the executive
  commissioner.
         SECTION 9.  Chapter 531, Government Code, is amended by
  adding Subchapter P to read as follows:
  SUBCHAPTER P. PHYSICIAN-CENTERED NURSING FACILITY MODEL
  DEMONSTRATION PROJECT
         Sec. 531.601.  DEFINITIONS. In this subchapter:
               (1)  "Nursing facility" has the meaning assigned by
  Section 242.301, Health and Safety Code.
               (2)  "Project" means the physician-centered nursing
  facility model demonstration project implemented under this
  subchapter.
         Sec. 531.602.  PHYSICIAN-CENTERED NURSING FACILITY MODEL
  DEMONSTRATION PROJECT. (a)  The commission may develop and
  implement a demonstration project to determine whether paying an
  enhanced Medicaid reimbursement rate to a nursing facility that
  provides continuous, on-site oversight of residents by physicians
  specializing in geriatric medicine results in:
               (1)  improved overall health of residents of that
  facility; and
               (2)  cost savings resulting from a reduction of acute
  care hospitalization and pharmaceutical costs.
         (b)  In developing the project, the commission may consider
  similar physician-centered nursing facility models implemented in
  other states to determine the most cost-effective measures to
  implement in the project under this subchapter.
         (c)  The commission may consider whether the project could
  involve the Medicare program, subject to federal law and approval.
         Sec. 531.603.  REPORT.  (a)  If the commission develops and
  implements the project, the commission shall, not later than
  December 1, 2008, submit a preliminary status report to the
  governor, the lieutenant governor, the speaker of the house of
  representatives, and the chairs of the standing committees of the
  senate and house of representatives having primary jurisdiction
  over the Medicaid program.  The report must:
               (1)  describe the project, including the
  implementation and performance of the project during the preceding
  year; and
               (2)  evaluate the operation of the project.
         (b)  If the commission develops and implements the project,
  the commission shall submit a subsequent report to the persons
  listed in Subsection (a) preceding the regular session of the 82nd
  Legislature.  The report must make recommendations regarding:
               (1)  the continuation or expansion of the project, to
  be determined based on the cost-effectiveness of the project; and
               (2)  if the commission recommends expanding the
  project, any necessary statutory or budgetary changes.
         Sec. 531.604.  EXPIRATION. This subchapter expires
  September 1, 2011.
         SECTION 10.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.0051 to read as follows:
         Sec. 533.0051.  PERFORMANCE MEASURES AND INCENTIVES FOR
  VALUE-BASED CONTRACTS. (a)  The commission shall establish
  outcome-based performance measures and incentives to include in
  each contract between a health maintenance organization and the
  commission for the provision of health care services to recipients
  that is procured and managed under a value-based purchasing model.  
  The performance measures and incentives must be designed to
  facilitate and increase recipients' access to appropriate health
  care services.
         (b)  Subject to Subsection (c), the commission shall include
  the performance measures and incentives established under
  Subsection (a) in each contract described by that subsection in
  addition to all other contract provisions required by this chapter.
         (c)  The commission may use a graduated approach to including
  the performance measures and incentives established under
  Subsection (a) in contracts described by that subsection to ensure
  incremental and continued improvements over time.
         (d)  Subject to Subsection (f), the commission shall assess
  the feasibility and cost-effectiveness of including provisions in a
  contract described by Subsection (a) that require the health
  maintenance organization to provide to the providers in the
  organization's provider network pay-for-performance opportunities
  that support quality improvements in the care of Medicaid
  recipients.  Pay-for-performance opportunities may include
  incentives for providers to provide care after normal business
  hours and to participate in the early and periodic screening,
  diagnosis, and treatment program and other activities that improve
  Medicaid recipients' access to care. If the commission determines
  that the provisions are feasible and may be cost-effective, the
  commission shall develop and implement a pilot program in at least
  one health care service region under which the commission will
  include the provisions in contracts with health maintenance
  organizations offering managed care plans in the region.
         (e)  The commission shall post the financial statistical
  report on the commission's web page in a comprehensive and
  understandable format.
         (f)  The commission shall, to the extent possible, base an
  assessment of feasibility and cost-effectiveness under Subsection
  (d) on publicly available, scientifically valid, evidence-based
  criteria appropriate for assessing the Medicaid population.
         (g)  In performing the commission's duties under Subsection
  (d) with respect to assessing feasibility and cost-effectiveness,
  the commission may consult with physicians, including those with
  expertise in quality improvement and performance measurement, and
  hospitals.
         SECTION 11.  (a)  Subsection (c), Section 533.012,
  Government Code, is amended to read as follows:
         (c)  The commission's office of investigations and
  enforcement shall review the information submitted under this
  section as appropriate in the investigation of fraud in the
  Medicaid managed care program.  [The comptroller may review the
  information in connection with the health care fraud study
  conducted by the comptroller.]
         (b)  Section 403.028, Government Code, is repealed.
         SECTION 12.  (a)  Subchapter A, Chapter 533, Government
  Code, is amended by adding Section 533.019 to read as follows:
         Sec. 533.019.  VALUE-ADDED SERVICES. The commission shall
  actively encourage managed care organizations that contract with
  the commission to offer benefits, including health care services or
  benefits or other types of services, that:
               (1)  are in addition to the services ordinarily covered
  by the managed care plan offered by the managed care organization;
  and
               (2)  have the potential to improve the health status of
  enrollees in the plan.
         (b)  The changes in law made by Section 533.019, Government
  Code, as added by this section, apply to a contract between the
  Health and Human Services Commission and a managed care
  organization under Chapter 533, Government Code, that is entered
  into or renewed on or after the effective date of this section.  The
  commission shall seek to amend contracts entered into with managed
  care organizations under that chapter before the effective date of
  this section to authorize those managed care organizations to offer
  value-added services to enrollees in accordance with Section
  533.019, Government Code, as added by this section.
  SECTION 13.  (a)  Subtitle C, Title 2, Health and Safety
  Code, is amended by adding Chapter 75 to read as follows:
  CHAPTER 75.  REGIONAL OR LOCAL HEALTH CARE PROGRAMS FOR EMPLOYEES OF
  SMALL EMPLOYERS
  SUBCHAPTER A.  GENERAL PROVISIONS
         Sec. 75.001.  PURPOSE.  The purpose of this chapter is to:
               (1)  improve the health of employees of small employers
  and their families by improving the employees' access to health
  care and by reducing the number of those employees who are
  uninsured;
               (2)  reduce the likelihood that those employees and
  their families will require services from state-funded entitlement
  programs such as Medicaid;
               (3)  contribute to economic development by helping
  small businesses remain competitive with a healthy workforce and
  health care benefits that will attract employees; and
               (4)  encourage innovative solutions for providing and
  funding health care services and benefits.
         Sec. 75.002.  DEFINITIONS.  In this chapter:
               (1)  "Employee" means an individual employed by an
  employer.  The term includes a partner of a partnership and the
  proprietor of a sole proprietorship.
               (2)  "Governing body" means:
                     (A)  the commissioners courts of the counties
  participating in a regional health care program;
                     (B)  the commissioners court of a county
  participating in a local health care program; or
                     (C)  the governing body of the joint council,
  nonprofit entity exempt from federal taxation, or other entity that
  operates a regional or local health care program.
               (3)  "Local health care program" means a local health
  care program operating in one county and established for the
  benefit of the employees of small employers under Subchapter B.
               (4)  "Regional health care program" means a regional
  health care program operating in two or more counties and
  established for the benefit of the employees of small employers
  under Subchapter B.
               (5)  "Small employer" means a person who employed an
  average of at least two employees but not more than 50 employees on
  business days during the preceding calendar year and who employs at
  least two employees on the first day of the plan year.
  [Sections 75.003-75.050 reserved for expansion]
  SUBCHAPTER B.  REGIONAL OR LOCAL HEALTH CARE PROGRAM
         Sec. 75.051.  ESTABLISHMENT OF PROGRAM; MULTICOUNTY
  COOPERATION.  (a)  The commissioners court of a county may, by
  order, establish or participate in a local health care program
  under this subchapter.
         (b)  The commissioners courts of two or more counties may, by
  joint order, establish or participate in a regional health care
  program under this subchapter.
         Sec. 75.052.  GOVERNANCE OF PROGRAM.  (a)  A regional health
  care program may be operated subject to the direct governance of the
  commissioners courts of the participating counties.  A local health
  care program may be operated subject to the direct governance of the
  commissioners court of the participating county.  A regional or
  local health care program may be operated by a joint council,
  tax-exempt nonprofit entity, or other entity that:
               (1)  operates the program under a contract with the
  commissioners court or courts, as applicable; or
               (2)  is an entity in which the county or counties
  participate or that is established or designated by the
  commissioners court or courts, as applicable, to operate the
  program.
         (b)  In selecting an entity described by Subsection (a)(1) or
  (2) to operate a regional or local health care program, the
  commissioners court or courts, as applicable, shall require, to the
  extent possible, that the entity be authorized under federal law to
  accept donations on a basis that is tax-deductible or otherwise
  tax-advantaged for the contributor.
         Sec. 75.053.  OPERATION OF PROGRAM.  A regional or local
  health care program provides health care services or benefits to
  the employees of participating small employers who are located
  within the boundaries of the participating county or counties, as
  applicable.  A program may also provide services or benefits to the
  dependents of those employees.
         Sec. 75.054.  PARTICIPATION BY SMALL EMPLOYERS; SHARE OF
  COST.  Subject to Section 75.153, the governing body may establish
  criteria for participation in a regional or local health care
  program by small employers, the employees of the small employers,
  and their dependents.  The criteria must require that participating
  employers and participating employees pay a share of the premium or
  other cost of the program.
         Sec. 75.055.  ADDITIONAL FUNDING.  (a)  A governing body may
  accept and use state money made available through an appropriation
  from the general revenue fund or a gift, grant, or donation from any
  source to operate the regional or local health care program and to
  provide services or benefits under the program.
         (b)  A governing body may apply for and receive funding from
  the health opportunity pool trust fund under Subchapter D.
         (b-1)  A governing body may apply for and receive a grant
  under Subchapter E to support a regional or local health care
  program if money is appropriated for that purpose.  This subsection
  expires September 1, 2009.
         (c)  A governing body shall actively solicit gifts, grants,
  and donations to:
               (1)  fund services and benefits provided under the
  regional or local health care program; and
               (2)  reduce the cost of participation in the program
  for small employers and their employees.
  [Sections 75.056-75.100 reserved for expansion]
  SUBCHAPTER C.  HEALTH CARE SERVICES AND BENEFITS
         Sec. 75.101.  ALTERNATIVE PROGRAMS AUTHORIZED; PROGRAM
  OBJECTIVES.  In developing a regional or local health care program,
  a governing body may provide health care services or benefits as
  described by this subchapter or may develop another type of program
  to accomplish the purposes of this chapter.  A regional or local
  health care program must be developed, to the extent practicable,
  to:
               (1)  reduce the number of individuals without health
  benefit plan coverage within the boundaries of the participating
  county or counties;
               (2)  address rising health care costs and reduce the
  cost of health care services or health benefit plan coverage for
  small employers and their employees within the boundaries of the
  participating county or counties;
               (3)  promote preventive care and reduce the incidence
  of preventable health conditions, such as heart disease, cancer,
  and diabetes and low birth weight in infants;
               (4)  promote efficient and collaborative delivery of
  health care services;
               (5)  serve as a model for the innovative use of health
  information technology to promote efficient delivery of health care
  services, reduce health care costs, and improve the health of the
  community; and
               (6)  provide fair payment rates for health care
  providers.
         Sec. 75.102.  HEALTH BENEFIT PLAN COVERAGE.  (a)  A regional
  or local health care program may provide health care benefits to the
  employees of small employers by purchasing or facilitating the
  purchase of health benefit plan coverage for those employees from a
  health benefit plan issuer, including coverage under:
               (1)  a small employer health benefit plan offered under
  Chapter 1501, Insurance Code;
               (2)  a standard health benefit plan offered under
  Chapter 1507, Insurance Code; or
               (3)  any other health benefit plan available in this
  state.
         (b)  The governing body may form one or more cooperatives
  under Subchapter B, Chapter 1501, Insurance Code.
         (c)  Notwithstanding Chapter 1251, Insurance Code, an
  insurer may issue a group accident and health insurance policy,
  including a group contract issued by a group hospital service
  corporation, to cover the employees of small employers
  participating in a regional or local health care program.  The group
  policyholder of a policy issued in accordance with this subsection
  is the governing body or the designee of the governing body.
         (d)  A health maintenance organization may issue a health
  care plan to cover the employees of small employers participating
  in a regional or local health care program.  The group contract
  holder of a contract issued in accordance with this subsection is
  the governing body or the designee of the governing body.
         Sec. 75.103.  OTHER HEALTH BENEFIT PLANS OR PROGRAMS.  To the
  extent authorized by federal law, the governing body may establish
  or facilitate the establishment of self-funded health benefit plans
  or may facilitate the provision of health benefit coverage through
  health savings accounts and high-deductible health plans.
         Sec. 75.104.  HEALTH CARE SERVICES.  (a)  A regional or
  local health care program may contract with health care providers
  within the boundaries of the participating county or counties to
  provide health care services directly to the employees of
  participating small employers and the dependents of those
  employees.
         (b)  A regional or local health care program shall allow any
  individual who receives state premium assistance to buy into the
  health benefit plan offered by the regional or local health care
  program.
         (c)  A governing body that operates a regional or local
  health care program under this section may require that
  participating employees and dependents obtain health care services
  only from health care providers that contract to provide those
  services under the program and may limit the health care services
  provided under the program to services provided within the
  boundaries of the participating county or counties.
         (d)  A governing body operating a regional or local health
  care program operated under this section is not an insurer or health
  maintenance organization and the program is not subject to
  regulation by the Texas Department of Insurance.
  [Sections 75.105-75.150 reserved for expansion]
  SUBCHAPTER D.  TEXAS HEALTH OPPORTUNITY POOL FUNDS
         Sec. 75.151.  DEFINITION.  In this subchapter, "health
  opportunity pool trust fund" means the trust fund established under
  Subchapter N, Chapter 531, Government Code.
         Sec. 75.152.  FUNDING AUTHORIZED.  Notwithstanding any other
  law, a regional or local health care program may apply for funding
  from the health opportunity pool trust fund and the fund may provide
  funding in accordance with this subchapter.
         Sec. 75.153.  ELIGIBILITY FOR FUNDS; STATEWIDE ELIGIBILITY
  CRITERIA.  To be eligible for funding from money in the health
  opportunity pool trust fund, a regional or local health care
  program must:
               (1)  comply with any requirement imposed under the
  waiver obtained under Section 531.502, Government Code, including,
  to the extent applicable, any requirement that health care benefits
  or services provided under the program be provided in accordance
  with statewide eligibility criteria; and
               (2)  provide health care benefits or services under the
  program to a person receiving premium payment assistance for health
  benefits coverage through a program established under Section
  531.507, Government Code, regardless of whether the person is an
  employee, or dependent of an employee, of a small employer.
  [Sections 75.154-75.200 reserved for expansion]
  SUBCHAPTER E.  GRANTS FOR DEMONSTRATION PROJECTS
         Sec. 75.201.  DEFINITIONS.  In this subchapter:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Executive commissioner" means the executive
  commissioner of the commission.
         Sec. 75.202.  GRANT PROGRAM.  (a)  The executive
  commissioner may establish a grant program to support the initial
  establishment and operation of one or more regional or local health
  care programs as demonstration projects, subject to the
  appropriation of money for this purpose.
         (b)  In selecting grant recipients, the executive
  commissioner shall consider the extent to which the regional or
  local health care program proposed by the applicant accomplishes
  the purposes of this chapter and meets the objectives established
  under Section 75.101.
         (c)  The commission shall establish performance objectives
  for a grant recipient and shall monitor the performance of the grant
  recipient.
         Sec. 75.203.  REVIEW OF DEMONSTRATION PROJECT; REPORT.  Not
  later than December 1, 2008, the commission shall complete a review
  of each regional or local health care program that receives a grant
  under this subchapter and shall submit to the governor, the
  lieutenant governor, and the speaker of the house of
  representatives a report that includes:
               (1)  an evaluation of the success of regional and local
  health care programs in accomplishing the purposes of this chapter;
  and
               (2)  the commission's recommendations for any
  legislation needed to facilitate or improve regional and local
  health care programs.
         Sec. 75.204.  EXPIRATION.  This subchapter expires September
  1, 2009.
         (b)  The heading to Subtitle C, Title 2, Health and Safety
  Code, is amended to read as follows:
  SUBTITLE C.  PROGRAMS PROVIDING [INDIGENT] HEALTH CARE BENEFITS AND
  SERVICES
         SECTION 14.  (a)  Subsection (a), Section 773.004, Health
  and Safety Code, is amended to read as follows:
         (a)  This chapter does not apply to:
               (1)  [a ground transfer vehicle and staff used to
  transport a patient who is under a physician's care between medical
  facilities or between a medical facility and a private residence,
  unless it is medically necessary to transport the patient using a
  stretcher;
               [(2)]  air transfer that does not advertise as an
  ambulance service and that is not licensed by the department;
               (2) [(3)]  the use of ground or air transfer vehicles
  to transport sick or injured persons in a casualty situation that
  exceeds the basic vehicular capacity or capability of emergency
  medical services providers in the area;
               (3) [(4)]  an industrial ambulance; or
               (4) [(5)]  a physician, registered nurse, or other
  health care practitioner licensed by this state unless the health
  care practitioner staffs an emergency medical services vehicle
  regularly.
         (b)  Section 773.041, Health and Safety Code, is amended by
  adding Subsection (a-1) to read as follows:
         (a-1)  A person may not transport a patient by stretcher in a
  vehicle unless the person holds a license as an emergency medical
  services provider issued by the department in accordance with this
  chapter. For purposes of this subsection, "person" means an
  individual, corporation, organization, government, governmental
  subdivision or agency, business, trust, partnership, association,
  or any other legal entity.
         (c)  Not later than May 1, 2008, the executive commissioner
  of the Health and Human Services Commission shall adopt the rules
  necessary to implement the changes in law made by this section to
  Chapter 773, Health and Safety Code.
         SECTION 15.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.0214 to read as follows:
         Sec. 32.0214.  DESIGNATIONS OF PRIMARY CARE PROVIDER BY
  CERTAIN RECIPIENTS. (a)  If the department determines that it is
  cost-effective and feasible and subject to Subsection (b), the
  department shall require each recipient of medical assistance to
  designate a primary care provider with whom the recipient will have
  a continuous, ongoing professional relationship and who will
  provide and coordinate the recipient's initial and primary care,
  maintain the continuity of care provided to the recipient, and
  initiate any referrals to other health care providers.
         (b)  A recipient who receives medical assistance through a
  Medicaid managed care model or arrangement under Chapter 533,
  Government Code, that requires the designation of a primary care
  provider shall designate the recipient's primary care provider as
  required by that model or arrangement.
         SECTION 16.  Section 32.024, Human Resources Code, is
  amended by adding Subsection (y-1) to read as follows:
         (y-1)  A woman who receives a breast or cervical cancer
  screening service under Title XV of the Public Health Service Act
  (42 U.S.C. Section 300k et seq.) and who otherwise meets the
  eligibility requirements for medical assistance for treatment of
  breast or cervical cancer as provided by Subsection (y) is eligible
  for medical assistance under that subsection, regardless of whether
  federal Medicaid matching funds are available for that medical
  assistance. A screening service of a type that is within the scope
  of screening services under that title is considered to be provided
  under that title regardless of whether the service was provided by a
  provider who receives or uses funds under that title.
         SECTION 17.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.02471 to read as follows:
         Sec. 32.02471.  MEDICAL ASSISTANCE FOR CERTAIN FORMER FOSTER
  CARE ADOLESCENTS ENROLLED IN HIGHER EDUCATION.  (a)  In this
  section, "independent foster care adolescent" has the meaning
  assigned by Section 32.0247.
         (b)  The department shall provide medical assistance to a
  person who:
               (1)  is 21 years of age or older but younger than 23
  years of age;
               (2)  would be eligible to receive assistance as an
  independent foster care adolescent under Section 32.0247 if the
  person were younger than 21 years of age; and
               (3)  is enrolled in an institution of higher education,
  as defined by Section 61.003(8), Education Code, or a private or
  independent institution of higher education, as defined by Section
  61.003(15), Education Code, that is located in this state and is
  making satisfactory academic progress as determined by the
  institution.
         SECTION 18.  Section 32.0422, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0422.  HEALTH INSURANCE PREMIUM PAYMENT
  REIMBURSEMENT PROGRAM FOR MEDICAL ASSISTANCE RECIPIENTS. (a)  In
  this section:
               (1)  "Commission" ["Department"] means the Health and
  Human Services Commission [Texas Department of Health].
               (2)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
               (3)  "Group health benefit plan" means a plan described
  by Section 1207.001, Insurance Code.
         (b)  The commission [department] shall identify individuals,
  otherwise entitled to medical assistance, who are eligible to
  enroll in a group health benefit plan. The commission [department]
  must include individuals eligible for or receiving health care
  services under a Medicaid managed care delivery system.
         (b-1)  To assist the commission in identifying individuals
  described by Subsection (b):
               (1)  the commission shall include on an application for
  medical assistance and on a form for recertification of a
  recipient's eligibility for medical assistance:
                     (A)  an inquiry regarding whether the applicant or
  recipient, as applicable, is eligible to enroll in a group health
  benefit plan; and
                     (B)  a statement informing the applicant or
  recipient, as applicable, that reimbursements for required
  premiums and cost-sharing obligations under the group health
  benefit plan may be available to the applicant or recipient; and
               (2)  not later than the 15th day of each month, the
  office of the attorney general shall provide to the commission the
  name, address, and social security number of each newly hired
  employee reported to the state directory of new hires operated
  under Chapter 234, Family Code, during the previous calendar month.
         (c)  The commission [department] shall require an individual
  requesting medical assistance or a recipient, during the
  recipient's eligibility recertification review, to provide
  information as necessary relating to any [the availability of a]
  group health benefit plan that is available to the individual or
  recipient through an employer of the individual or recipient  or an
  employer of the individual's or recipient's spouse or parent to
  assist the commission in making the determination required by
  Subsection (d).
         (d)  For an individual identified under Subsection (b), the
  commission [department] shall determine whether it is
  cost-effective to enroll the individual in the group health benefit
  plan under this section.
         (e)  If the commission [department] determines that it is
  cost-effective to enroll the individual in the group health benefit
  plan, the commission [department] shall:
               (1)  require the individual to apply to enroll in the
  group health benefit plan as a condition for eligibility under the
  medical assistance program; and
               (2)  provide written notice to the issuer of the group
  health benefit plan in accordance with Chapter 1207, Insurance
  Code.
         (e-1)  This subsection applies only to an individual who is
  identified under Subsection (b) as being eligible to enroll in a
  group health benefit plan offered by an employer. If the commission
  determines under Subsection (d) that enrolling the individual in
  the group health benefit plan is not cost-effective, but the
  individual prefers to enroll in that plan instead of receiving
  benefits and services under the medical assistance program, the
  commission, if authorized by a waiver obtained under federal law,
  shall:
               (1)  allow the individual to voluntarily opt out of
  receiving services through the medical assistance program and
  enroll in the group health benefit plan;
               (2)  consider that individual to be a recipient of
  medical assistance; and
               (3)  provide written notice to the issuer of the group
  health benefit plan in accordance with Chapter 1207, Insurance
  Code.
         (f)  Except as provided by Subsection (f-1), the commission
  [The department] shall provide for payment of:
               (1)  the employee's share of required premiums for
  coverage of an individual enrolled in the group health benefit
  plan; and
               (2)  any deductible, copayment, coinsurance, or other
  cost-sharing obligation imposed on the enrolled individual for an
  item or service otherwise covered under the medical assistance
  program.
         (f-1)  For an individual described by Subsection (e-1) who
  enrolls in a group health benefit plan, the commission shall
  provide for payment of the employee's share of the required
  premiums, except that if the employee's share of the required
  premiums exceeds the total estimated Medicaid costs for the
  individual, as determined by the executive commissioner, the
  individual shall pay the difference between the required premiums
  and those estimated costs. The individual shall also pay all
  deductibles, copayments, coinsurance, and other cost-sharing
  obligations imposed on the individual under the group health
  benefit plan.
         (g)  A payment made by the commission [department] under
  Subsection (f) or (f-1) is considered to be a payment for medical
  assistance.
         (h)  A payment of a premium for an individual who is a member
  of the family of an individual enrolled in a group health benefit
  plan under Subsection (e) [this section] and who is not eligible for
  medical assistance is considered to be a payment for medical
  assistance for an eligible individual if:
               (1)  enrollment of the family members who are eligible
  for medical assistance is not possible under the plan without also
  enrolling members who are not eligible; and
               (2)  the commission [department] determines it to be
  cost-effective.
         (i)  A payment of any deductible, copayment, coinsurance, or
  other cost-sharing obligation of a family member who is enrolled in
  a group health benefit plan in accordance with Subsection (h) and
  who is not eligible for medical assistance:
               (1)  may not be paid under this chapter; and
               (2)  is not considered to be a payment for medical
  assistance for an eligible individual.
         (i-1)  The commission shall make every effort to expedite
  payments made under this section, including by ensuring that those
  payments are made through electronic transfers of money to the
  recipient's account at a financial institution, if possible. In
  lieu of reimbursing the individual enrolled in the group health
  benefit plan for required premium or cost-sharing payments made by
  the individual, the commission may, if feasible:
               (1)  make payments under this section for required
  premiums directly to the employer providing the group health
  benefit plan in which an individual is enrolled; or
               (2)  make payments under this section for required
  premiums and cost-sharing obligations directly to the group health
  benefit plan issuer.
         (j)  The commission [department] shall treat coverage under
  the group health benefit plan as a third party liability to the
  program. Subject to Subsection (j-1), enrollment [Enrollment] of
  an individual in a group health benefit plan under this section does
  not affect the individual's eligibility for medical assistance
  benefits, except that the state is entitled to payment under
  Sections 32.033 and 32.038.
         (j-1)  An individual described by Subsection (e-1) who
  enrolls in a group health benefit plan is not ineligible for
  community-based services provided under a Section 1915(c) waiver
  program or another federal waiver program solely based on the
  individual's enrollment in the group health benefit plan, and the
  individual may receive those services if the individual is
  otherwise eligible for the program.  The individual is otherwise
  limited to the health benefits coverage provided under the health
  benefit plan in which the individual is enrolled, and the
  individual may not receive any benefits or services under the
  medical assistance program other than the premium payment as
  provided by Subsection (f-1) and, if applicable, waiver program
  services described by this subsection.
         (k)  The commission [department] may not require or permit an
  individual who is enrolled in a group health benefit plan under this
  section to participate in the Medicaid managed care program under
  Chapter 533, Government Code, or a Medicaid managed care
  demonstration project under Section 32.041.
         (l)  The commission, in consultation with the Texas
  Department of Insurance, shall provide training to agents who hold
  a general life, accident, and health license under Chapter 4054,
  Insurance Code, regarding the health insurance premium payment
  reimbursement program and the eligibility requirements for
  participation in the program. Participation in a training program
  established under this subsection is voluntary, and a general life,
  accident, and health agent who successfully completes the training
  is entitled to receive continuing education credit under Subchapter
  B, Chapter 4004, Insurance Code, in accordance with rules adopted
  by the commissioner of insurance.
         (m)  The commission may pay a referral fee, in an amount
  determined by the commission, to each general life, accident, and
  health agent who, after completion of the training program
  established under Subsection (l), successfully refers an eligible
  individual to the commission for enrollment in a [Texas Department
  of Human Services shall provide information and otherwise cooperate
  with the department as necessary to ensure the enrollment of
  eligible individuals in the] group health benefit plan under this
  section.
         (n)  The commission shall develop procedures by which an
  individual described by Subsection (e-1) who enrolls in a group
  health benefit plan may, at the individual's option, resume
  receiving benefits and services under the medical assistance
  program instead of the group health benefit plan.
         (o)  The commission shall develop procedures which ensure
  that, prior to allowing an individual described by Subsection (e-1)
  to enroll in a group health benefit plan or allowing the parent or
  caretaker of an individual described by Subsection (e-1) under the
  age of 21 to enroll that child in a group health benefit plan:
               (1)  the individual must receive counseling informing
  them that for the period in which the individual is enrolled in the
  group health benefit plan:
                     (A)  the individual shall be limited to the health
  benefits coverage provided under the health benefit plan in which
  the individual is enrolled;
                     (B)  the individual may not receive any benefits
  or services under the medical assistance program other than the
  premium payment as provided by Subsection (f-1);
                     (C)  the individual shall pay the difference
  between the required premiums and the premium payment as provided
  by Subsection (f-1) and shall also pay all deductibles, copayments,
  coinsurance, and other cost-sharing obligations imposed on the
  individual under the group health benefit plan; and
                     (D)  the individual may, at the individual's
  option through procedures developed by the commission, resume
  receiving benefits and services under the medical assistance
  program instead of the group health benefit plan; and
               (2)  the individual must sign and the commission shall
  retain a copy of a waiver indicating the individual has provided
  informed consent.
         (p)  The executive commissioner [department] shall adopt
  rules as necessary to implement this section.
         SECTION 19.  (a)  Section 32.058, Human Resources Code, is
  amended to read as follows:
         Sec. 32.058.  LIMITATION ON MEDICAL ASSISTANCE IN CERTAIN
  ALTERNATIVE COMMUNITY-BASED CARE SETTINGS. (a)  In this section,
  "medical assistance waiver program" means a program administered by
  the Department of Aging and Disability Services, other than the
  Texas home living program, that provides services under a waiver
  granted in accordance with 42 U.S.C. Section 1396n(c)[:
               [(1)     "Institution" means a nursing facility or an
  ICF-MR facility.
               [(2)  "Medical assistance waiver program" means:
                     [(A)  the community-based alternatives program;
                     [(B)     the community living assistance and support
  services program;
                     [(C)     the deaf-blind/multiple disabilities
  program;
                     [(D)  the consolidated waiver pilot program; or
                     [(E)  the medically dependent children program].
         (b)  Except as provided by Subsection (c), [or] (d), (e), or
  (f), the department may not provide services under a medical
  assistance waiver program to a person [receiving medical
  assistance] if the projected cost of providing those services over
  a 12-month period exceeds the individual cost limit specified in
  the medical assistance waiver program.
         (c)  The department shall continue to provide services under
  a medical assistance waiver program to a person who was [is]
  receiving those services on September 1, 2005, at a cost that
  exceeded [exceeds] the individual cost limit specified in the
  medical assistance waiver program, if continuation of those
  services:
               (1)  is necessary for the person to live in the most
  integrated setting appropriate to the needs of the person; and
               (2)  does not affect the department's compliance with
  the federal average per capita expenditure requirement
  [cost-effectiveness and efficiency requirements] of the medical
  assistance waiver program under 42 U.S.C. Section [Sections
  1396n(b) and] 1396n(c)(2)(D).
         (d)  The department may continue to provide services under a
  medical assistance waiver program, other than the home and
  community-based services program, to a person who is ineligible to
  receive those services under Subsection (b) and to whom Subsection
  (c) does not apply if:
               (1)  the projected cost of providing those services to
  the person under the medical assistance waiver program over a
  12-month period does not exceed 133.3 percent of the individual
  cost limit specified in the medical assistance waiver program; and
               (2)  continuation of those services does not affect the
  department's compliance with the federal average per capita
  expenditure requirement [cost-effectiveness and efficiency
  requirements] of the medical assistance waiver program under 42
  U.S.C. Section [Sections 1396n(b) and] 1396n(c)(2)(D).
         (e)  The department may exempt a person from the cost limit
  established under Subsection (d)(1) for a medical assistance waiver
  program if the department determines that:
               (1)  the person's health and safety cannot be protected
  by the services provided within the cost limit established for the
  program under that subdivision; and
               (2)  there is no available living arrangement, other
  than one provided through the program or another medical assistance
  waiver program, in which the person's health and safety can be
  protected, as evidenced by:
                     (A)  an assessment conducted by clinical staff of
  the department; and
                     (B)  supporting documentation, including the
  person's medical and service records.
         (f)  The department may continue to provide services under
  the home and community-based services program to a person who is
  ineligible to receive those services under Subsection (b) and to
  whom Subsection (c) does not apply if the department makes, with
  regard to the person's receipt of services under the home and
  community-based services program, the same determinations required
  by Subsections (e)(1) and (2) in the same manner provided by
  Subsection (e) and determines that continuation of those services
  does not affect:
               (1)  the department's compliance with the federal
  average per capita expenditure requirement of the home and
  community-based services program under 42 U.S.C. Section
  1396n(c)(2)(D); and
               (2)  any cost-effectiveness requirements provided by
  the General Appropriations Act that limit expenditures for the home
  and community-based services program.
         (g)  The executive commissioner of the Health and Human
  Services Commission may adopt rules to implement Subsections (d),
  (e), and (f) [under which the department may exempt a person from
  the cost limit established under Subsection (d)(1)].
         (h)  If a federal agency determines that compliance with any
  provision in this section would make this state ineligible to
  receive federal funds to administer a program to which this section
  applies, a state agency may, but is not required to, implement that
  provision.
         (b)  The changes in law made by this section apply only to a
  person receiving medical assistance on or after the effective date
  of this section, regardless of when eligibility for that assistance
  was determined.
         SECTION 20.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.0641 to read as follows:
         Sec. 32.0641.  COST SHARING FOR CERTAIN HIGH-COST MEDICAL
  SERVICES.  (a)  If the department determines that it is feasible
  and cost-effective, and to the extent permitted under Title XIX,
  Social Security Act (42 U.S.C. Section 1396 et seq.) and any other
  applicable law or regulation or under a federal waiver or other
  authorization, the executive commissioner of the Health and Human
  Services Commission shall adopt cost-sharing provisions that
  require a recipient who chooses a high-cost medical service
  provided through a hospital emergency room to pay a copayment,
  premium payment, or other cost-sharing payment for the high-cost
  medical service if:
               (1)  the hospital from which the recipient seeks
  service:
                     (A)  performs an appropriate medical screening
  and determines that the recipient does not have a condition
  requiring emergency medical services;
                     (B)  informs the recipient:
                           (i)  that the recipient does not have a
  condition requiring emergency medical services;
                           (ii)  that, if the hospital provides the
  nonemergency service, the hospital may require payment of a
  copayment, premium payment, or other cost-sharing payment by the
  recipient in advance; and
                           (iii)  of the name and address of a
  nonemergency Medicaid provider who can provide the appropriate
  medical service without imposing a cost-sharing payment; and
                     (C)  offers to provide the recipient with a
  referral to the nonemergency provider to facilitate scheduling of
  the service; and
               (2)  after receiving the information and assistance
  described by Subdivision (1) from the hospital, the recipient
  chooses to obtain emergency medical services despite having access
  to medically acceptable, lower-cost medical services.
         (b)  The department may not seek a federal waiver or other
  authorization under Subsection (a) that would:
               (1)  prevent a Medicaid recipient who has a condition
  requiring emergency medical services from receiving care through a
  hospital emergency room; or
               (2)  waive any provision under Section 1867, Social
  Security Act (42 U.S.C. Section 1395dd).
         (c)  If the executive commissioner of the Health and Human
  Services Commission adopts a copayment or other cost-sharing
  payment under Subsection (a), the commission may not reduce
  hospital payments to reflect the potential receipt of a copayment
  or other payment from a recipient receiving medical services
  provided through a hospital emergency room.
         SECTION 21.  (a)  Subchapter B, Chapter 32, Human Resources
  Code, is amended by adding Section 32.072 to read as follows:
         Sec. 32.072.  DIRECT ACCESS TO EYE HEALTH CARE SERVICES.
  (a)  Notwithstanding any other law, a recipient of medical
  assistance is entitled to:
               (1)  select an ophthalmologist or therapeutic
  optometrist who is a medical assistance provider to provide eye
  health care services, other than surgery, that are within the scope
  of:
                     (A)  services provided under the medical
  assistance program; and
                     (B)  the professional specialty practice for
  which the ophthalmologist or therapeutic optometrist is licensed
  and credentialed; and
               (2)  have direct access to the selected ophthalmologist
  or therapeutic optometrist for the provision of the nonsurgical
  services without any requirement to obtain:
                     (A)  a referral from a primary care physician or
  other gatekeeper or health care coordinator; or
                     (B)  any other prior authorization or
  precertification.
         (b)  The department may require an ophthalmologist or
  therapeutic optometrist selected as provided by this section by a
  recipient of medical assistance who is otherwise required to have a
  primary care physician or other gatekeeper or health care
  coordinator to forward to the recipient's physician, gatekeeper, or
  health care coordinator information concerning the eye health care
  services provided to the recipient.
         (c)  This section may not be construed to expand the scope of
  eye health care services provided under the medical assistance
  program.
         (b)  Subchapter A, Chapter 533, Government Code, is amended
  by adding Section 533.0026 to read as follows:
         Sec. 533.0026.  DIRECT ACCESS TO EYE HEALTH CARE SERVICES
  UNDER MEDICAID MANAGED CARE MODEL OR ARRANGEMENT.  
  (a)  Notwithstanding any other law, the commission shall ensure
  that a managed care plan offered by a managed care organization that
  contracts with the commission under this chapter and any other
  Medicaid managed care model or arrangement implemented under this
  chapter allow a Medicaid recipient who receives services through
  the plan or other model or arrangement to, in the manner and to the
  extent required by Section 32.072, Human Resources Code:
               (1)  select an in-network ophthalmologist or
  therapeutic optometrist in the managed care network to provide eye
  health care services, other than surgery; and
               (2)  have direct access to the selected in-network
  ophthalmologist or therapeutic optometrist for the provision of the
  nonsurgical services.
         (b)  This section does not affect the obligation of an
  ophthalmologist or therapeutic optometrist in a managed care
  network to comply with the terms and conditions of the managed care
  plan.
         (c)  The changes in law made by Section 533.0026, Government
  Code, as added by this section, apply to a contract between the
  Health and Human Services Commission and a managed care
  organization under Chapter 533, Government Code, that is entered
  into or renewed on or after the effective date of this section.
         SECTION 22.  Chapter 32, Human Resources Code, is amended by
  adding Subchapter C to read as follows:
  SUBCHAPTER C. ELECTRONIC COMMUNICATIONS
         Sec. 32.101.  DEFINITIONS.  In this subchapter:
               (1)  "Electronic health record" means electronically
  originated and maintained health and claims information regarding
  the health status of an individual that may be derived from multiple
  sources and includes the following core functionalities:
                     (A)  a patient health and claims information or
  data entry function to aid with medical diagnosis, nursing
  assessment, medication lists, allergy recognition, demographics,
  clinical narratives, and test results;
                     (B)  a results management function that may
  include computerized laboratory test results, diagnostic imaging
  reports, interventional radiology reports, and automated displays
  of past and present medical or laboratory test results;
                     (C)  a computerized physician order entry of
  medication, care orders, and ancillary services;
                     (D)  clinical decision support that may include
  electronic reminders and prompts to improve prevention, diagnosis,
  and management; and
                     (E)  electronic communication and connectivity
  that allows online communication:
                           (i)  among physicians and health care
  providers; and
                           (ii)  among the Health and Human Services
  Commission, the operating agencies, and participating providers.
               (2)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
               (3)  "Health care provider" means a person, other than
  a physician, who is licensed or otherwise authorized to provide a
  health care service in this state.
               (4)  "Health information technology" means information
  technology used to improve the quality, safety, or efficiency of
  clinical practice, including the core functionalities of an
  electronic health record, electronic medical record, computerized
  physician or health care provider order entry, electronic
  prescribing, and clinical decision support technology.
               (5)  "Operating agency" means a health and human
  services agency operating part of the medical assistance program.
               (6)  "Participating provider" means a physician or
  health care provider who is a provider of medical assistance,
  including a physician or health care provider who contracts or
  otherwise agrees with a managed care organization to provide
  medical assistance under this chapter.
               (7)  "Physician" means an individual licensed to
  practice medicine in this state under the authority of Subtitle B,
  Title 3, Occupations Code, or a person that is:
                     (A)  a professional association of physicians
  formed under the Texas Professional Association Law, as described
  by Section 1.008, Business Organizations Code;
                     (B)  an approved nonprofit health corporation
  certified under Chapter 162, Occupations Code, that employs or
  contracts with physicians to provide medical services;
                     (C)  a medical and dental unit, as defined by
  Section 61.003, Education Code, a medical school, as defined by
  Section 61.501, Education Code, or a health science center
  described by Subchapter K, Chapter 74, Education Code, that employs
  or contracts with physicians to teach or provide medical services,
  or employs physicians and contracts with physicians in a practice
  plan; or
                     (D)  a person wholly owned by a person described
  by Paragraph (A), (B), or (C).
               (8)  "Recipient" means a recipient of medical
  assistance.
         Sec. 32.102.  ELECTRONIC COMMUNICATIONS.  (a)  To the extent
  allowed by federal law, the executive commissioner may adopt rules
  allowing the Health and Human Services Commission to permit,
  facilitate, and implement the use of health information technology
  for the medical assistance program to allow for electronic
  communication among the commission, the operating agencies, and
  participating providers for:
               (1)  eligibility, enrollment, verification procedures,
  and prior authorization for health care services or procedures
  covered by the medical assistance program, as determined by the
  executive commissioner, including diagnostic imaging;
               (2)  the update of practice information by
  participating providers;
               (3)  the exchange of recipient health care information,
  including electronic prescribing and electronic health records;
               (4)  any document or information requested or required
  under the medical assistance program by the Health and Human
  Services Commission, the operating agencies, or participating
  providers; and
               (5)  the enhancement of clinical and drug information
  available through the vendor drug program to ensure a comprehensive
  electronic health record for recipients.
         (b)  If the executive commissioner determines that a need
  exists for the use of health information technology in the medical
  assistance program and that the technology is cost-effective, the
  Health and Human Services Commission may, for the purposes
  prescribed by Subsection (a):
               (1)  acquire and implement the technology; or
               (2)  evaluate the feasibility of developing and, if
  feasible, develop, the technology through the use or expansion of
  other systems or technologies the commission uses for other
  purposes, including:
                     (A)  the technologies used in the pilot program
  implemented under Section 531.1063, Government Code; and
                     (B)  the health passport developed under Section
  266.006, Family Code.
         (c)  The commission:
               (1)  must ensure that health information technology
  used under this section complies with the applicable requirements
  of the Health Insurance Portability and Accountability Act;
               (2)  may require the health information technology used
  under this section to include technology to extract and process
  claims and other information collected, stored, or accessed by the
  medical assistance program, program contractors, participating
  providers, and state agencies operating any part of the medical
  assistance program for the purpose of providing patient information
  at the location where the patient is receiving care;
               (3)  must ensure that a paper record or document is not
  required to be filed if the record or document is permitted or
  required to be filed or transmitted electronically by rule of the
  executive commissioner;
               (4)  may provide for incentives to participating
  providers to encourage their use of health information technology
  under this subchapter;
               (5)  may provide recipients with a method to access
  their own health information; and
               (6)  may present recipients with an option to decline
  having their health information maintained in an electronic format
  under this subchapter.
         (d)  The executive commissioner shall consult with
  participating providers and other interested stakeholders in
  developing any proposed rules under this section. The executive
  commissioner shall request advice and information from those
  stakeholders concerning the proposed rules, including advice
  regarding the impact of and need for a proposed rule.
         SECTION 23.  (a)  Chapter 32, Human Resources Code, is
  amended by adding Subchapter D to read as follows:
  SUBCHAPTER D. ELECTRONIC HEALTH INFORMATION PILOT PROGRAM
         Sec. 32.151.  DEFINITIONS. In this subchapter:
               (1)  "Electronic health record" means an ambulatory
  electronic health record that is certified by the Certification
  Commission for Healthcare Information Technology or that meets
  other federally approved interoperability standards.
               (2)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
               (3)  "Health information technology" means information
  technology used to improve the quality, safety, and efficiency of
  clinical practice, including the core functionalities of an
  electronic health record, computerized physician order entry,
  electronic prescribing, and clinical decision support technology.
               (4)  "Provider" means:
                     (A)  an individual licensed to practice medicine
  in this state under Subtitle B, Title 3, Occupations Code;
                     (B)  a professional association of four or fewer
  physicians formed under the Texas Professional Association Law, as
  described by Section 1.008, Business Organizations Code; or
                     (C)  an advanced practice nurse licensed and
  authorized to practice under Subtitle E, Title 3, Occupations Code.
               (5)  "Recipient" means a recipient of medical
  assistance.
         Sec. 32.152.  ELECTRONIC HEALTH INFORMATION PILOT PROGRAM.  
  The executive commissioner, from money appropriated for this
  purpose, shall develop and implement a pilot program for providing
  health information technology, including electronic health
  records, for use by primary care providers who provide medical
  assistance to recipients.
         Sec. 32.153.  PROVIDER PARTICIPATION. For participation in
  the pilot program, the department shall select providers who:
               (1)  volunteer to participate in the program;
               (2)  are providers of medical assistance, including
  providers who contract or otherwise agree with a managed care
  organization to provide medical assistance under this chapter; and
               (3)  demonstrate that at least 40 percent of the
  providers' practice involves the provision of primary care services
  to recipients in the medical assistance program.
         Sec. 32.154.  SECURITY OF PERSONALLY IDENTIFIABLE HEALTH
  INFORMATION.  (a)  Personally identifiable health information of
  recipients enrolled in the pilot program must be maintained in an
  electronic format or technology that meets interoperability
  standards that are recognized by the Certification Commission for
  Healthcare Information Technology or other federally approved
  certification standards.
         (b)  The system used to access a recipient's electronic
  health record must be secure and maintain the confidentiality of
  the recipient's personally identifiable health information in
  accordance with applicable state and federal law.
         Sec. 32.155.  GIFTS, GRANTS, AND DONATIONS. The department
  may request and accept gifts, grants, and donations from public or
  private entities for the implementation of the pilot program.
         Sec. 32.156.  PROTECTED HEALTH INFORMATION.  To the extent
  that this subchapter authorizes the use or disclosure of protected
  health information by a covered entity, as those terms are defined
  by the privacy rule of the Administrative Simplification subtitle
  of the Health Insurance Portability and Accountability Act of 1996
  (Pub. L. No. 104-191) contained in 45 C.F.R. Part 160 and 45 C.F.R.
  Part 164, Subparts A and E, the covered entity shall ensure that the
  use or disclosure complies with all applicable requirements,
  standards, or implementation specifications of the privacy rule.
         Sec. 32.157.  EXPIRATION OF SUBCHAPTER. This subchapter
  expires September 1, 2011.
         (b)  Not later than December 31, 2008, the executive
  commissioner of the Health and Human Services Commission shall
  submit to the governor, lieutenant governor, speaker of the house
  of representatives, presiding officer of the House Committee on
  Public Health, and presiding officer of the Senate Committee on
  Health and Human Services a report regarding the preliminary
  results of the pilot program established under Subchapter D,
  Chapter 32, Human Resources Code, as added by this section, and any
  recommendations regarding expansion of the pilot program,
  including any recommendations for legislation and requests for
  appropriation necessary for the expansion of the pilot program.
         SECTION 24.  (a)  Subsection (a), Section 1207.002,
  Insurance Code, is amended to read as follows:
         (a)  A group health benefit plan issuer shall permit an
  individual who is otherwise eligible for enrollment in the plan to
  enroll in the plan, without regard to any enrollment period
  restriction, on receipt of written notice from the Health and Human
  Services Commission [or a designee of the commission stating] that
  the individual is:
               (1)  a recipient of medical assistance under the state
  Medicaid program and is a participant in the health insurance
  premium payment reimbursement program under Section 32.0422, Human
  Resources Code; or
               (2)  a child eligible for [enrolled in] the state child
  health plan under Chapter 62, Health and Safety Code, and eligible
  to participate [is a participant] in the health insurance premium
  assistance program under Section 62.059, Health and Safety Code.
         (b)  Section 1207.003, Insurance Code, is amended to read as
  follows:
         Sec. 1207.003.  EFFECTIVE DATE OF ENROLLMENT.  (a)  Unless
  enrollment occurs during an established enrollment period,
  enrollment in a group health benefit plan under Section 1207.002
  takes effect on:
               (1)  the eligibility enrollment date specified in the
  written notice from the Health and Human Services Commission under
  Section 1207.002(a); or
               (2)  the first day of the first calendar month that
  begins at least 30 days after the date written notice or a written
  request is received by the plan issuer under Section 1207.002(a) or
  (b), as applicable.
         (b)  Notwithstanding Subsection (a), the individual must
  comply with a waiting period required under the state child health
  plan under Chapter 62, Health and Safety Code, or under the health
  insurance premium assistance program under Section 62.059, Health
  and Safety Code, as applicable.
         (c)  Subsection (b), Section 1207.004, Insurance Code, is
  amended to read as follows:
         (b)  Notwithstanding any other requirement of a group health
  benefit plan, the plan issuer shall permit an individual who is
  enrolled in the plan under Section 1207.002(a)(2), and any family
  member of the individual enrolled under Section 1207.002(c), to
  terminate enrollment in the plan not later than the 60th day after
  the date on which the individual provides a written request to
  disenroll from the plan because the individual [satisfactory proof
  to the issuer that the child is] no longer wishes to participate [a
  participant] in the health insurance premium assistance program
  under Section 62.059, Health and Safety Code.
         SECTION 25.  Subtitle G, Title 8, Insurance Code, is amended
  by adding Chapter 1508 to read as follows:
  CHAPTER 1508. HEALTHY TEXAS PROGRAM
         Sec. 1508.001.  STUDY; REPORT. (a)  The commissioner shall
  conduct a study concerning a Healthy Texas Program, under which
  small employer health plan coverage would be offered through the
  program to persons who would be eligible for that coverage.
         (b)  The study shall include a market analysis to assist in
  identification of underserved segments in the voluntary small
  employer group health benefit plan coverage market in this state.
         (c)  The commissioner, using existing resources, may
  contract with actuaries and other experts as necessary to conduct
  the study.
         (d)  Not later than November 1, 2008, the commissioner shall
  provide a report to the governor, the lieutenant governor, the
  speaker of the house of representatives, and the members of the
  legislature addressing the results of the study concerning the
  Healthy Texas Program. The report must include an analysis and
  information regarding:
               (1)  the advantages and disadvantages of the proposed
  program;
               (2)  prospective structure and function of the program
  and its components;
               (3)  prospective program design and administration,
  including fundamental operational procedures, powers and duties of
  the commissioner, and powers and duties of the program board of
  directors;
               (4)  recommendations for program eligibility criteria
  and minimum standards applicable to group health benefit plans that
  may be included in the program;
               (5)  identification of other program requirements or
  restrictions and limitations necessary for successful
  implementation of the program;
               (6)  the potential economic impact that the program
  would have on the small employer insurance market in this state;
               (7)  the anticipated impact that the program would have
  on the quality of health care provided in this state; and
               (8)  recommendations for any statutory changes to
  address implementation of the program.
         Sec. 1508.002.  EXPIRATION.  This chapter expires September
  1, 2009.
         SECTION 26.  (a)  The Texas Health Care Policy Council, in
  coordination with the Institute for Demographic and Socioeconomic
  Research at The University of Texas at San Antonio, the Regional
  Center for Health Workforce Studies at the Center for Health
  Economics and Policy of The University of Texas Health Science
  Center at San Antonio, and the Texas Medical Board, shall conduct a
  study regarding increasing:
               (1)  the number of medical residency programs and
  medical residents in this state; and
               (2)  the number of physicians practicing medical
  specialties.
         (b)  The study must:
               (1)  examine the feasibility of using a percentage of
  physician licensing fees to increase the number of medical
  residency programs and medical residents in this state;
               (2)  put emphasis on, and recommend a plan of action
  for, increasing the number of:
                     (A)  medical residency programs and medical
  residents in medically underserved areas of this state; and
                     (B)  physicians practicing medical specialties
  that are underrepresented in this state; and
               (3)  determine the number of medical residents that
  obtain a license to practice medicine in this state on completion of
  a medical residency program in this state.
         (c)  Not later than December 1, 2008, the Texas Health Care
  Policy Council shall:
               (1)  report the results of the study to the governor,
  the lieutenant governor, and the speaker of the house of
  representatives; and
               (2)  make available the raw data from the study to the
  governor, the lieutenant governor, the speaker of the house of
  representatives, the House Committee on Public Health, and the
  Senate Committee on Health and Human Services.
         (d)  The Texas Health Care Policy Council may accept gifts,
  grants, and donations of any kind from any source for the purposes
  of this section.
         (e)  This section expires January 1, 2009.
         SECTION 27.  (a)  In this section, "committee" means the
  committee on health and long-term care insurance incentives.
         (b)  The committee on health and long-term care insurance
  incentives is established to study and develop recommendations
  regarding methods by which this state may reduce:
               (1)  the need for residents of this state to rely on the
  Medicaid program by providing incentives for employers to provide
  health insurance, long-term care insurance, or both, to their
  employees; and
               (2)  the number of individuals in the state who are not
  covered by health insurance or long-term care insurance.
         (c)  The committee on health and long-term care insurance
  incentives is composed of:
               (1)  the presiding officers of:
                     (A)  the Senate Committee on Health and Human
  Services;
                     (B)  the House Committee on Public Health;
                     (C)  the Senate Committee on State Affairs; and
                     (D)  the House Committee on Insurance;
               (2)  three public members, appointed by the governor,
  who collectively represent the diversity of businesses in this
  state, including diversity with respect to:
                     (A)  the geographic regions in which those
  businesses are located;
                     (B)  the types of industries in which those
  businesses are engaged; and
                     (C)  the sizes of those businesses, as determined
  by number of employees; and
               (3)  the following ex officio members:
                     (A)  the comptroller of public accounts;
                     (B)  the commissioner of insurance; and
                     (C)  the executive commissioner of the Health and
  Human Services Commission.
         (d)  The committee shall elect a presiding officer from the
  committee members and shall meet at the call of the presiding
  officer.
         (e)  The committee shall study and develop recommendations
  regarding incentives this state may provide to employers to
  encourage those employers to provide health insurance, long-term
  care insurance, or both, to employees who would otherwise rely on
  the Medicaid program to meet their health and long-term care needs.
  In conducting the study, the committee shall:
               (1)  examine the feasibility and determine the cost of
  providing incentives through:
                     (A)  the franchise tax under Chapter 171, Tax
  Code, including allowing exclusions from an employer's total
  revenue of insurance premiums paid for employees, regardless of
  whether the employer chooses under Subparagraph (ii), Paragraph
  (B), Subdivision (1), Subsection (a), Section 171.101, Tax Code, as
  effective January 1, 2008, to subtract cost of goods sold or
  compensation for purposes of determining the employer's taxable
  margin;
                     (B)  deductions from or refunds of other taxes
  imposed on the employer; and
                     (C)  any other means, as determined by the
  committee; and
               (2)  for each incentive the committee examines under
  Subdivision (1) of this subsection, determine the impact that
  implementing the incentive would have on reducing the number of
  individuals in this state who do not have private health or
  long-term care insurance coverage, including individuals who are
  Medicaid recipients.
         (e-1) The committee shall:
               (1)  study and develop recommendations regarding:
                     (A)  the cost of health care coverage under health
  benefit plans and how to reduce the cost of coverage through the
  following or other methods:
                           (i)  changes in health benefit plan design
  or scope of services covered;
                           (ii)  improvements in disease management and
  other utilization review practices by health care providers and
  health benefit plans;
                           (iii)  reductions in administrative costs
  incurred by health care providers and health benefit plans;
                           (iv)  improvements in the use of health care
  information technology by health care providers and health benefit
  plans; and
                           (v)  development of a reinsurance system for
  health care claims in excess of $50,000; and
                     (B)  the availability of health care coverage
  under health benefit plans and how to expand health care coverage
  through the following or other methods:
                           (i)  the providing of premium subsidies for
  health benefit plan coverage by the state or local political
  subdivisions, including three-share or multiple-share programs;
                           (ii)  the inclusion of individuals or
  employees of private employers under state or local political
  subdivision health benefit plans, including the Texas Health
  Insurance Risk Pool;
                           (iii)  inclusion of family members and
  dependents under a group health benefit plan regardless of age; and
                           (iv)  requiring vendors of state and local
  political subdivisions to provide health benefit plan coverage for
  their employees and the employee's family and dependents; and
               (2)  provide information obtained in studying the
  issues under Subdivision (1) of this subsection to the Health and
  Human Services Commission and the Texas Department of Insurance for
  purposes of developing a health benefits coverage premium payment
  assistance program under Section 531.507, Government Code, as added
  by this Act.
         (f)  Not later than September 1, 2008, the committee shall
  submit to the Senate Committee on Health and Human Services, the
  House Committee on Public Health, the Senate Committee on State
  Affairs, and the House Committee on Insurance a report regarding
  the results of the study required by this section. The report must
  include a detailed description of each incentive the committee
  examined and determined is feasible and, for each of those
  incentives, specify:
               (1)  the anticipated cost associated with providing
  that incentive;
               (2)  any statutory changes needed to implement the
  incentive; and
               (3)  the impact that implementing the incentive would
  have on reducing:
                     (A)  the number of individuals in this state who
  do not have private health or long-term care insurance coverage;
  and
                     (B)  the number of individuals in this state who
  are Medicaid recipients.
         SECTION 28.  (a)  The Health and Human Services Commission
  shall conduct a study regarding the feasibility and
  cost-effectiveness of developing and implementing an integrated
  Medicaid managed care model designed to improve the management of
  care provided to Medicaid recipients who are aging, blind, or
  disabled or have chronic health care needs and are not enrolled in a
  managed care plan offered under a capitated Medicaid managed care
  model, including recipients who reside in:
               (1)  rural areas of this state; or
               (2)  urban or surrounding areas in which the Medicaid
  Star + Plus program or another capitated Medicaid managed care
  model is not available.
         (b)  Not later than September 1, 2008, the Health and Human
  Services Commission shall submit a report regarding the results of
  the study to the standing committees of the senate and house of
  representatives having primary jurisdiction over the Medicaid
  program.
         SECTION 29.  (a)  In this section:
               (1)  "Child health plan program" means the state child
  health plan program authorized by Chapter 62, Health and Safety
  Code.
               (2)  "Medicaid" means the medical assistance program
  provided under Chapter 32, Human Resources Code.
         (b)  The Health and Human Services Commission shall conduct a
  study of the feasibility of providing a health passport for:
               (1)  children under 19 years of age who are receiving
  Medicaid and are not provided a health passport under another law of
  this state; and
               (2)  children enrolled in the child health plan
  program.
         (c)  The feasibility study must:
               (1)  examine the cost-effectiveness of the use of a
  health passport in conjunction with the coordination of health care
  services under each program;
               (2)  identify any barriers to the implementation of the
  health passport developed for each program and recommend strategies
  for the removal of those barriers;
               (3)  examine whether the use of a health passport will
  improve the quality of care for children described in Subsection
  (b) of this section; and
               (4)  determine the fiscal impact to this state of the
  proposed initiative.
         (d)  Not later than January 1, 2009, the Health and Human
  Services Commission shall submit to the governor, lieutenant
  governor, speaker of the house of representatives, and presiding
  officers of each standing committee of the legislature with
  jurisdiction over the commission a written report containing the
  findings of the study and the commission's recommendations.
         (e)  This section expires September 1, 2009.
         SECTION 30.  (a)  The Medicaid Reform Legislative Oversight
  Committee is created to facilitate the reform efforts in Medicaid,
  the process of addressing the issues of uncompensated hospital
  care, and the establishment of programs addressing the uninsured.
         (b)  The committee is composed of eight members, as follows:
               (1)  four members of the senate, appointed by the
  lieutenant governor not later than October 1, 2007; and
               (2)  four members of the house of representatives,
  appointed by the speaker of the house of representatives not later
  than October 1, 2007.
         (c)  A member of the committee serves at the pleasure of the
  appointing official.
         (d)  The lieutenant governor shall designate a member of the
  committee as the presiding officer.
         (e)  A member of the committee may not receive compensation
  for serving on the committee but is entitled to reimbursement for
  travel expenses incurred by the member while conducting the
  business of the committee as provided by the General Appropriations
  Act.
         (f)  The committee shall:
               (1)  facilitate the design and development of any
  Medicaid waivers needed to affect reform as directed by this Act;
               (2)  facilitate a smooth transition from existing
  Medicaid payment systems and benefit designs to the new model of
  Medicaid enabled by waiver or policy change by the Health and Human
  Services Commission;
               (3)  meet at the call of the presiding officer; and
               (4)  research, take public testimony, and issue reports
  requested by the lieutenant governor or speaker of the house of
  representatives.
         (g)  The committee may:
               (1)  request reports and other information from the
  Health and Human Services Commission; and
               (2)  review the findings of the work group on
  uncompensated hospital care established under Section 531.552,
  Government Code, as added by this Act.
         (h)  The committee shall use existing staff of the senate,
  the house of representatives, and the Texas Legislative Council to
  assist the committee in performing its duties under this section.
         (i)  Chapter 551, Government Code, applies to the committee.
         (j)  The committee shall report to the lieutenant governor
  and speaker of the house of representatives not later than November
  15, 2008. The report must include:
               (1)  identification of significant issues that impede
  the transition to a more effective Medicaid program;
               (2)  the measures of effectiveness associated with
  changes to the Medicaid program;
               (3)  the impact of Medicaid changes on safety net
  hospitals and other significant traditional providers; and
               (4)  the impact on the uninsured in Texas.
         (k)  This section expires September 1, 2009, and the
  committee is abolished on that date.
         (l)  This section takes effect immediately if this Act
  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 this section to
  have immediate effect, this section takes effect September 1, 2007.
         SECTION 31.  (a)  In this section:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Department" means the Texas Department of
  Insurance.
         (b)  The department and the commission shall jointly study a
  small employer premium assistance program to provide financial
  assistance for the purchase of small employer health benefit plans
  by small employers.
         (c)  The study conducted under this section must address:
               (1)  options for program funding, including use of
  money in the Texas health opportunity pool trust fund as described
  by Section 531.507, Government Code, as added by this Act;
               (2)  coordination with any other premium assistance
  effort operated, under development, or under consideration by
  either agency; and
               (3)  recommended program design, including:
                     (A)  the manner of targeting small employers;
                     (B)  provisions to discourage employers and
  others from electing to discontinue other private coverage for
  employees;
                     (C)  a minimum premium, or percentage of premium,
  that a small employer must pay for each eligible employee's
  coverage;
                     (D)  eligibility requirements for enrollees for
  whom financial assistance is provided to individuals;
                     (E)  allocation of opportunities for enrollment
  in the program;
                     (F)  the duration of enrollment in the program and
  requirements for renewal; and
                     (G)  verification that small employers
  participating in the program use premium assistance to purchase and
  maintain a small employer health benefit plan.
         (d)  In conducting the study, the department and the
  commission may consider programs and efforts undertaken by other
  states to provide premium assistance to small employers.
         (e)  Not later than November 1, 2008, the department and the
  commission shall jointly submit a report to the legislature.  The
  report must summarize the results of the study conducted under this
  section and the recommendations of the department and commission
  and may include recommendations for proposed legislation to
  implement a small employer premium assistance program as described
  by Subsection (b) of this section.
         SECTION 32.  (a)  Subject to the appropriation of funds for
  these purposes and Subsection (c) of this section, all powers,
  duties, functions, activities, obligations, rights, contracts,
  records, assets, personal property, personnel, and appropriations
  or other money of the Texas Department of Transportation that are
  essential to the administration of the medical transportation
  program, as specified in Section 531.0057, Government Code, as
  added by this Act, are transferred to the Health and Human Services
  Commission.
         (b)  A reference in law or an administrative rule to the
  Texas Department of Transportation that relates to the medical
  transportation program means the Health and Human Services
  Commission.
         (c)  The Texas Department of Transportation shall take all
  action necessary to provide for the transfer of its contractual
  obligations to administer the medical transportation program, as
  specified in Section 531.0057, Government Code, as added by this
  Act, to the Health and Human Services Commission as soon as possible
  after the effective date of this section but not later than
  September 1, 2008.
         (d)  Effective September 1, 2008, Subsection (a), Section
  461.012, Health and Safety Code, is amended to read as follows:
         (a)  The commission shall:
               (1)  provide for research and study of the problems of
  chemical dependency in this state and seek to focus public
  attention on those problems through public information and
  education programs;
               (2)  plan, develop, coordinate, evaluate, and
  implement constructive methods and programs for the prevention,
  intervention, treatment, and rehabilitation of chemical dependency
  in cooperation with federal and state agencies, local governments,
  organizations, and persons, and provide technical assistance,
  funds, and consultation services for statewide and community-based
  services;
               (3)  cooperate with and enlist the assistance of:
                     (A)  other state, federal, and local agencies;
                     (B)  hospitals and clinics;
                     (C)  public health, welfare, and criminal justice
  system authorities;
                     (D)  educational and medical agencies and
  organizations; and
                     (E)  other related public and private groups and
  persons;
               (4)  expand chemical dependency services for children
  when funds are available because of the long-term benefits of those
  services to the state and its citizens;
               (5)  sponsor, promote, and conduct educational
  programs on the prevention and treatment of chemical dependency,
  and maintain a public information clearinghouse to purchase and
  provide books, literature, audiovisuals, and other educational
  material for the programs;
               (6)  sponsor, promote, and conduct training programs
  for persons delivering prevention, intervention, treatment, and
  rehabilitation services and for persons in the criminal justice
  system or otherwise in a position to identify chemically dependent
  persons and their families in need of service;
               (7)  require programs rendering services to chemically
  dependent persons to safeguard those persons' legal rights of
  citizenship and maintain the confidentiality of client records as
  required by state and federal law;
               (8)  maximize the use of available funds for direct
  services rather than administrative services;
               (9)  consistently monitor the expenditure of funds and
  the provision of services by all grant and contract recipients to
  assure that the services are effective and properly staffed and
  meet the standards adopted under this chapter;
               (10)  make the monitoring reports prepared under
  Subdivision (9) a matter of public record;
               (11)  license treatment facilities under Chapter 464;
               (12)  use funds appropriated to the commission to carry
  out this chapter and maximize the overall state allotment of
  federal funds;
               (13)  develop and implement policies that will provide
  the public with a reasonable opportunity to appear before the
  commission and to speak on any issue under the commission's
  jurisdiction;
               (14)  establish minimum criteria that peer assistance
  programs must meet to be governed by and entitled to the benefits of
  a law that authorizes licensing and disciplinary authorities to
  establish or approve peer assistance programs for impaired
  professionals;
               (15)  adopt rules governing the functions of the
  commission, including rules that prescribe the policies and
  procedures followed by the commission in administering any
  commission programs;
               (16)  plan, develop, coordinate, evaluate, and
  implement constructive methods and programs to provide healthy
  alternatives for youth at risk of selling controlled substances;
               (17)  submit to the federal government reports and
  strategies necessary to comply with Section 1926 of the federal
  Alcohol, Drug Abuse, and Mental Health Administration
  Reorganization Act, Pub. L. 102-321 (42 U.S.C. Section 300x-26);
  reports and strategies are to be coordinated with appropriate state
  governmental entities; and
               (18)  regulate, coordinate, and provide training for
  alcohol awareness courses required under Section 106.115,
  Alcoholic Beverage Code, and may charge a fee for an activity
  performed by the commission under this subdivision[; and
               [(19)     contract with the Texas Department of
  Transportation for the Texas Department of Transportation to assume
  all responsibilities of the commission relating to the provision of
  transportation services for clients of eligible programs].
         (e)  Notwithstanding Subdivision (19), Subsection (a),
  Section 461.012, Health and Safety Code, the Health and Human
  Services Commission shall implement that section only to the extent
  necessary until the commission effects the transfer of the medical
  transportation program, as specified in Section 531.0057,
  Government Code, as added by this Act, to the commission not later
  than September 1, 2008.
         (f)  The following sections remain in effect until September
  1, 2008, for the limited purpose of effecting the transfer of the
  medical transportation program, as specified in Section 531.0057,
  Government Code, as added by this Act.  The following sections are
  repealed, effective September 1, 2008:
               (1)  Subsection (b), Section 531.02412, Government
  Code;
               (2)  Subsection (g), Section 461.012, Health and Safety
  Code;
               (3)  Subsection (b), Section 533.012, Health and Safety
  Code;
               (4)  Subsection (e), Section 22.001, Human Resources
  Code;
               (5)  Subsection (f), Section 40.002, Human Resources
  Code;
               (6)  Subsection (g), Section 91.021, Human Resources
  Code;
               (7)  Subsection (b), Section 101.0256, Human Resources
  Code;
               (8)  Subsection (d), Section 111.0525, Human Resources
  Code;
               (9)  Section 455.0015, Transportation Code; and
               (10)  Section 461.003, Transportation Code.
         SECTION 33.  SEVERABILITY.  If any provision of this Act is
  held by a court to be invalid, that invalidity does not affect the
  other provisions of this Act, and to this end the provisions of this
  Act are severable.
         SECTION 34.  If before implementing any provision of this
  Act a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 35.  Except as otherwise provided by this Act, this
  Act takes effect September 1, 2007.
 
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 10 passed the Senate on
  April 17, 2007, by the following vote:  Yeas 30, Nays 0;
  May 24, 2007, Senate refused to concur in House amendments and
  requested appointment of Conference Committee; May 25, 2007, House
  granted request of the Senate; May 27, 2007, Senate adopted
  Conference Committee Report by the following vote:  Yeas 30,
  Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 10 passed the House, with
  amendments, on May 23, 2007, by the following vote:  Yeas 137,
  Nays 9, one present not voting; May 25, 2007, House granted request
  of the Senate for appointment of Conference Committee;
  May 27, 2007, House adopted Conference Committee Report by the
  following vote:  Yeas 145, Nays 3, two present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
             Date
 
 
  ______________________________ 
            Governor