Bill Text: TX SCR31 | 2021-2022 | 87th Legislature | Enrolled
Bill Title: Conferring legislative approval of the Coleman Settlement Agreement.
Spectrum: Partisan Bill (Republican 6-0)
Status: (Passed) 2021-06-14 - Signed by the Governor [SCR31 Detail]
Download: Texas-2021-SCR31-Enrolled.html
| S.C.R. No. 31 | ||
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| WHEREAS, Plaintiffs Dorena Coleman, Curtis Jackson, and | ||
| Federico Perez, individually, (collectively referred to as | ||
| "Plaintiffs"), filed suit on August 13, 2020, against the Texas | ||
| Health and Human Services Commission, including employees in their | ||
| official capacities ("HHSC"), and sought relief both on Plaintiffs' | ||
| own behalf and on behalf of a class of similarly situated | ||
| individuals ("Medicaid HCV Class"), and filed a motion for class | ||
| certification on August 14, 2020; and | ||
| WHEREAS, Plaintiffs alleged HHSC's Prior Authorization | ||
| Criteria and Policy's use of fibrosis score as criterion for direct | ||
| action antiviral drug (DAA) coverage violated Title XIX of the | ||
| Social Security Act: | ||
| (a) By discriminating among similarly situated Medicaid | ||
| recipients on the basis of categorical restrictions that are not | ||
| based upon prevailing clinical standards, as prohibited by 42 | ||
| U.S.C. § 1396a(a)(10)(B)(i) and (ii) and 42 C.F.R. § 440.240; | ||
| (b) By denying qualified Medicaid participants the | ||
| provision of necessary medical assistance and treatment coverage | ||
| with "reasonable promptness," as required by 42 U.S.C. § | ||
| 1396a(a)(8); | ||
| (c) By excluding qualified Medicaid recipients from | ||
| medically necessary treatment coverage as required by 42 U.S.C. § | ||
| 1396a(a)(10)(A); and | ||
| WHEREAS, Defendants denied the allegations of the Lawsuit, | ||
| denied all allegations of wrongdoing and liability, and denied any | ||
| causation of harm or damage to the Medicaid HCV Class; and | ||
| WHEREAS, The parties mediated this matter on December 1, | ||
| 2020, with the Honorable Patrick Keel as mediator, and thereafter | ||
| successfully reached an agreement in principle on December 17, | ||
| 2020; and | ||
| WHEREAS, The Parties have now agreed to a full settlement on | ||
| the following terms: | ||
| (a) HHSC will modify its Medicaid prior authorization (PA) | ||
| criteria to treat chronic Hepatitis C clients who have METAVIR | ||
| fibrosis scores of F2-F4 with Direct Acting Antiviral (DAA) | ||
| treatment by March 1, 2021; | ||
| (b) Between March 1, 2021, and September 1, 2021, Medicaid | ||
| enrollees with severe extrahepatic effects of chronic Hepatitis C | ||
| who have fibrosis scores other than F2-F4 will be approved for DAA | ||
| treatment on a case-by-case basis by the HHSC Chief Medical | ||
| Director or an MCO Medical Director, if they are assigned to an MCO; | ||
| (c) As of September 1, 2021, HHSC will remove all METAVIR | ||
| fibrosis score, drug screening, and specialist prescription PA | ||
| criteria requirements for DAA treatment for chronic Hepatitis C | ||
| clients, if the legislature approves the funding for HHSC's | ||
| Exceptional Item (EI); HHSC agrees that, for the period September | ||
| 1, 2021, through August 31, 2023, HHSC will not reinstate these | ||
| criteria; and | ||
| WHEREAS, This Agreement is expressly conditioned upon | ||
| approval by the Office of the Attorney General of Texas, the | ||
| Governor of Texas, and the Texas Legislature; and | ||
| WHEREAS, This Agreement is expressly conditioned upon | ||
| enactment by the Texas Legislature of the EI requested by HHSC; and | ||
| WHEREAS, Section 111.003(b), Texas Civil Practice and | ||
| Remedies Code, requires a state agency to obtain legislative | ||
| approval of a settlement agreement that "commits this state to a | ||
| course of action that in reasonable probability will entail a | ||
| continuing increased expenditure of state funds over subsequent | ||
| state fiscal bienniums"; therefore, the Settlement Agreement is | ||
| expressly conditioned upon the legislature approving and | ||
| appropriating the agreed upon settlement amount; now, therefore, be | ||
| it | ||
| RESOLVED, That the 87th Legislature of the State of Texas | ||
| hereby approve the proposed Settlement Agreement. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I hereby certify that S.C.R. No. 31 was adopted by the Senate | ||
| on May 19, 2021, by the following vote: Yeas 31, Nays 0. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| I hereby certify that S.C.R. No. 31 was adopted by the House | ||
| on May 29, 2021, by the following vote: Yeas 133, Nays 0, | ||
| one present not voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| Approved: | ||
| ______________________________ | ||
| Date | ||
| ______________________________ | ||
| Governor | ||
