Enrolled Bill Summary

            Senate Bill 445 amends the Health and Safety Code to create a child health plan (CHIP) to provide primary and preventive health care for certain low-income, uninsured children, subject to the availability of federal funds and appropriated money. At the implementation of the program, a child who is younger than 19 and whose net family income is at or below 200 percent of the federal poverty level, in addition to other requirements, is eligible for health benefits coverage.

            The act directs the Health and Human Services Commission to develop and coordinate a state-designed child health plan program that maximizes the use of private resources, allows a parent's employer or others to contribute to the program, and qualifies for federal funding under Title XXI of the Social Security Act. The act specifies that CHIP is not an entitlement and sets out requirements and procedures for the program. It also specifies that at the time the plan is first implemented it must provide covered benefits in substantial compliance with the recommended benefits package described in certain interim reports to the 76th Legislature and prohibits the plan's benefits from including certain reproductive services. Eligibility screening and enrollment procedures must ensure that Medicaid-eligible children are identified and referred to that program.

            The act requires the commission, or the Texas Department of Health in consultation with the commissioner, to select the health plan providers through a competitive procurement process.

            The commission is required to consider the health care needs of healthy children and children with special health care needs in developing coverage. To the extent permitted by law, the plan must include a waiting period and require enrollees to share costs of the program. The act also authorizes inclusion of other provisions to discourage individuals with access to adequate benefits from electing not to obtain or continue that coverage and to discourage employers from electing to discontinue offering coverage.

            The commission is authorized to direct the Texas Department of Health, the Texas Department of Human Resources, and the Texas Department of Insurance to perform certain duties relating to developing and administering the plan. It may contract for the implementation of the plan with third party administrators or other entities, including the Texas Healthy Kids Corporation. The act includes provisions authorizing the corporation to perform certain functions under the program. The commission is directed to conduct a community outreach and education campaign, to appoint regional advisory committees, and to develop and implement rules for the prevention and detection of fraud. The commission is required to provide coverage for certain qualified aliens by September 2000, and the act includes related requirements.

            Senate Bill 445 specifies that the first money becoming available to the state each fiscal year from the tobacco settlement must be used to fund the child health plan program and that the program terminates on the date that funding is no longer available, unless the legislature authorizes the use of other revenue. It requires the commission to develop the plan by September 1, 1999, and to establish the coverage program for qualified aliens by September 1, 2000, or when approved by Congress.