Bill Text: TX HB2981 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to establishment of the prescription drug savings program for certain uninsured individuals.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2021-03-18 - Referred to Insurance [HB2981 Detail]
Download: Texas-2021-HB2981-Introduced.html
87R12454 SCL-F | ||
By: Oliverson | H.B. No. 2981 |
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relating to establishment of the prescription drug savings program | ||
for certain uninsured individuals. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. This Act shall be known as the "Texas Cares Act." | ||
SECTION 2. Subtitle C, Title 2, Health and Safety Code, is | ||
amended by adding Chapter 65 to read as follows: | ||
CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN | ||
UNINSURED INDIVIDUALS | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 65.001. DEFINITIONS. In this chapter: | ||
(1) "Account" means the Texas cares account | ||
established under Section 65.101. | ||
(2) "Enrollee" means an individual enrolled in the | ||
program. | ||
(3) "Pharmacy benefit manager" means a person, other | ||
than a pharmacy or pharmacist, who acts as an administrator in | ||
connection with prescription drug discounts provided under the | ||
program. | ||
(4) "Program" means the prescription drug savings | ||
program established under this chapter. | ||
(5) "Uninsured individual" means an individual | ||
without health benefit plan coverage for a prescription drug | ||
benefit. | ||
Sec. 65.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This | ||
chapter does not establish an entitlement to assistance in | ||
obtaining benefits for uninsured individuals. | ||
(b) The purpose of this chapter is to make this state's risk | ||
pool whole by providing services to uninsured individuals without | ||
access to prescription drug benefits. | ||
Sec. 65.003. CONFLICT WITH FEDERAL LAW; REPORT. (a) The | ||
executive commissioner shall monitor federal law affecting the | ||
administration or facilitation of a prescription drug savings | ||
program. | ||
(b) If the executive commissioner determines that a federal | ||
law, rule, or regulation conflicts with this chapter, the executive | ||
commissioner shall provide a written report of the conflict to the | ||
governor, lieutenant governor, and speaker of the house of | ||
representatives. The report must include recommendations for | ||
legislation necessary to comply with federal law or recommendations | ||
for dissolution of a program established by this chapter that is | ||
duplicative of federal law. | ||
Sec. 65.004. RULES. (a) Except as provided by Subsection | ||
(b), the executive commissioner shall adopt rules as necessary to | ||
implement this chapter. | ||
(b) The executive commissioner may delegate rulemaking to | ||
another state agency with that agency's approval. If the executive | ||
commissioner delegates rulemaking under this subsection, the | ||
executive commissioner must approve the proposed rules of the | ||
delegated agency before the delegated agency adopts the rules. | ||
SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION | ||
DRUG SAVINGS PROGRAM | ||
Sec. 65.051. ESTABLISHMENT OF PROGRAM. (a) The commission | ||
shall develop and design a prescription drug savings program that | ||
partners with a pharmacy benefit manager to make prescription drugs | ||
available at a discounted rate to uninsured individuals. | ||
(b) In developing and implementing the program, the | ||
commission shall ensure that program benefits do not include | ||
prescription drugs to be used for the elective termination of a | ||
pregnancy. | ||
(c) The executive commissioner shall ensure that the | ||
program is designed in a manner that provides the greatest possible | ||
value to the uninsured individuals it serves, with considerations | ||
given to the adequacy of the prescription drug formulary, costs of | ||
drugs, cost to the state, and other important factors. | ||
Sec. 65.052. GENERAL DUTIES OF COMMISSION RELATED TO | ||
PROGRAM. (a) The commission shall oversee the implementation of | ||
the program and coordinate the activities of each state agency | ||
necessary for the implementation of the program, including the | ||
Texas Department of Insurance. | ||
(b) The commission shall maximize the use of private | ||
resources in administering the program. | ||
(c) The commission shall ensure that money spent | ||
administering the program does not exceed a limit on program | ||
expenditures imposed by the legislature. | ||
(d) The commission shall develop a method to accept | ||
applications for participation in the program, including a process | ||
to: | ||
(1) determine eligibility, screening, and enrollment | ||
procedures; and | ||
(2) resolve disputes related to eligibility | ||
determinations. | ||
Sec. 65.053. TEXAS DEPARTMENT OF INSURANCE DUTIES. At the | ||
request of the commission, the Texas Department of Insurance shall | ||
provide any necessary assistance with the development of the | ||
program. The Texas Department of Insurance shall monitor the | ||
quality of the services provided by a pharmacy benefit manager and | ||
resolve disputes relating to those services. | ||
Sec. 65.054. PHARMACY BENEFIT MANAGER CONTRACT AND | ||
REQUIREMENTS. (a) The commission shall enter into a contract with | ||
a pharmacy benefit manager to provide enrollment and related | ||
services throughout this state under the program. | ||
(b) The commission shall monitor, through reporting | ||
requirements or other means, the contracted pharmacy benefit | ||
manager to ensure performance under the contract and quality | ||
delivery of services. | ||
(c) The commission shall provide payments under a contract | ||
entered into under this section to the contracted pharmacy benefit | ||
manager. | ||
(d) A pharmacy benefit manager must hold a certificate of | ||
authority or other appropriate license issued by the Texas | ||
Department of Insurance that authorizes the pharmacy benefit | ||
manager to provide the type of coverage related to the services | ||
provided under the program. | ||
(e) A pharmacy benefit manager that provides health care | ||
services under the program must satisfy certification and licensure | ||
requirements prescribed by the commission and consistent with law. | ||
Sec. 65.055. CONTRACT ADMINISTRATION. (a) The commission | ||
may contract with a third-party administrator or other entity to | ||
administer the program for the commission under this chapter. | ||
(b) A third-party administrator or other entity may perform | ||
tasks under a contract entered into under Subsection (a) that would | ||
otherwise be performed by the commission. | ||
(c) The commission may not delegate decisions about the | ||
policies of the program to a third party administrator or other | ||
entity. | ||
Sec. 65.056. CONTRACT OVERSIGHT. (a) The commission shall | ||
conduct a review of each entity that enters into a contract under | ||
this subchapter to ensure the entity is available, prepared, and | ||
able to fulfill the entity's obligations under the contract in | ||
compliance with the contract, this chapter, and rules adopted under | ||
this chapter. | ||
(b) The commission's review of contractors under Subsection | ||
(a) must be based on the following criteria: | ||
(1) adequate and appropriate staffing, including | ||
contracts with third parties; | ||
(2) adequate and properly documented policies and | ||
procedures; | ||
(3) fiscal soundness; and | ||
(4) adequate information systems, electronic | ||
interfaces, and business practices. | ||
(c) The commission shall ensure that each contract entered | ||
into under this subchapter is procured using a competitive | ||
procurement process in compliance with all applicable federal and | ||
state laws, rules, and regulations. | ||
Sec. 65.057. COMMUNITY OUTREACH CAMPAIGN. The commission | ||
shall conduct a community outreach and education campaign in the | ||
form and manner determined by the commission to provide information | ||
relating to the availability of the program. | ||
SUBCHAPTER C. TEXAS CARES ACCOUNT; PROGRAM TERMINATION | ||
Sec. 65.101. ESTABLISHMENT OF TEXAS CARES ACCOUNT. (a) | ||
The Texas cares account is a dedicated account in the general | ||
revenue fund. | ||
(b) The account consists of: | ||
(1) gifts, grants, and donations received for the | ||
account; | ||
(2) legislative appropriations; | ||
(3) federal money available to be used for this | ||
purpose; and | ||
(4) interest, dividends, and other income of the | ||
account. | ||
(c) Section 403.0956, Government Code, does not apply to the | ||
account. | ||
(d) Money in the account may be appropriated only for the | ||
administration of the program and the provision of program | ||
services. | ||
(e) The commission may solicit and accept gifts, grants, and | ||
donations for the account. | ||
Sec. 65.102. TERMINATION OF PROGRAM. The commission may | ||
terminate the program if the commission determines the account | ||
under Section 65.101 lacks sufficient funding to administer the | ||
program. | ||
SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS | ||
Sec. 65.151. ELIGIBILITY CRITERIA. (a) Except as provided | ||
by Subsection (b), an individual is eligible for benefits under the | ||
program if the individual: | ||
(1) is a resident of this state; | ||
(2) is a citizen of the United States; and | ||
(3) is uninsured, as determined by the commission. | ||
(b) If the commission determines necessary, the commission | ||
may consider an applicant's financial vulnerability as an | ||
additional factor for determining program eligibility. | ||
(c) The executive commissioner by rule shall establish | ||
eligibility levels consistent with any other applicable federal and | ||
state laws, rules, and regulations. | ||
Sec. 65.152. COST SHARING. To the extent necessary, the | ||
commission shall require enrollees to share the cost of the | ||
program, including provisions requiring enrollees to pay a | ||
copayment at the point of service. | ||
SUBCHAPTER E. OPERATION OF PROGRAM | ||
Sec. 65.201. PROGRAM BENEFITS. (a) The commission may use | ||
money appropriated to the program in accordance with the General | ||
Appropriations Act and in the account to finance benefits for | ||
enrollees. | ||
(b) The commission must approve program benefits offered | ||
under this chapter. The commission shall ensure that the benefits | ||
comply with all applicable federal and state laws, rules, and | ||
regulations. | ||
Sec. 65.202. REPORTING. (a) A third-party administrator | ||
or other entity the commission contracts with under Section 65.055 | ||
shall report to the commission in the form and manner prescribed by | ||
the commission on the benefits and services provided under the | ||
program. | ||
(b) The commission shall establish a procedure to monitor | ||
the provision of benefits and services under this chapter. | ||
Sec. 65.203. FRAUD PREVENTION. The executive commissioner | ||
shall develop and implement rules for the prevention and detection | ||
of fraud in the program. | ||
SECTION 3. (a) In this section, "commission" means the | ||
Health and Human Services Commission. | ||
(b) The commission shall conduct a study on the development | ||
and implementation of the prescription drug savings program | ||
established by Chapter 65, Health and Safety Code, as added by this | ||
Act. The commission shall determine the effectiveness of the | ||
program in providing services to uninsured individuals in this | ||
state and any legislative recommendations for improvements to the | ||
program. | ||
(c) Not later than October 16, 2022, the commission shall | ||
provide a written report of the results of the study conducted under | ||
Subsection (b) of this section to the governor, lieutenant | ||
governor, speaker of the house of representatives, and members of | ||
the standing committees of the legislature with primary | ||
jurisdiction over the commission. | ||
SECTION 4. As soon as practicable after the effective date | ||
of this Act, the executive commissioner of the Health and Human | ||
Services Commission and any other state agency designated by the | ||
executive commissioner shall adopt rules necessary to implement | ||
Chapter 65, Health and Safety Code, as added by this Act. | ||
SECTION 5. This Act takes effect September 1, 2021. |