By McDonald H.B. No. 1211
74R5190 PB-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to enforcement of certain medical assistance support and
1-3 the duties of employers and insurers regarding that support.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Chapter 3, Insurance Code, is amended by adding
1-6 Subchapter J to read as follows:
1-7 SUBCHAPTER J. MEDICAL CHILD SUPPORT
1-8 Art. 3.96-1. DEFINITIONS. In this subchapter:
1-9 (1) "Child" means a son or daughter, including an
1-10 adult.
1-11 (2) "Child support agency" has the meaning assigned by
1-12 Section 14.80, Family Code.
1-13 (3) "Custodial parent" means:
1-14 (A) a managing conservator of a child or a
1-15 possessory conservator of a child who is a parent of the child; or
1-16 (B) a guardian of the person of a child, or
1-17 another custodian of a child if the guardian or custodian is
1-18 designated by a court or administrative agency of this or another
1-19 state.
1-20 (4) "Health insurer" means any insurance company,
1-21 group hospital service corporation, or health maintenance
1-22 organization that delivers or issues for delivery an individual,
1-23 group, blanket, or franchise insurance policy or insurance
1-24 agreement, a group hospital service contract, or an evidence of
2-1 coverage that provides benefits for medical or surgical expenses
2-2 incurred as a result of an accident or sickness.
2-3 (5) "Insurer" means:
2-4 (A) a health insurer;
2-5 (B) a governmental entity subject to:
2-6 (i) Article 3.51-1, 3.51-2, 3.51-4,
2-7 3.51-5, or 3.51-5A of this code; or
2-8 (ii) Section 1, Chapter 123, Acts of the
2-9 60th Legislature, Regular Session, 1967 (Article 3.51-3, Vernon's
2-10 Texas Insurance Code);
2-11 (C) a multiple employer welfare arrangement, as
2-12 that term is defined by Article 3.95-1 of this code; or
2-13 (D) a group health plan, as defined by Section
2-14 607(1), Employee Retirement Income Security Act of 1974 (29 U.S.C.
2-15 Section 1167).
2-16 (6) "Medical assistance" means medical assistance
2-17 under the state Medicaid program.
2-18 Art. 3.96-2. DENIAL OF ENROLLMENT PROHIBITED. An insurer
2-19 may not deny enrollment of a child under the health insurance
2-20 coverage of the child's parent on the ground that the child:
2-21 (1) has a preexisting condition;
2-22 (2) was born out of wedlock;
2-23 (3) is not claimed as a dependent on the parent's
2-24 federal income tax return;
2-25 (4) does not reside with the parent or in the
2-26 insurer's service area; or
2-27 (5) is or has been an applicant for or recipient of
3-1 medical assistance.
3-2 Art. 3.96-3. ENROLLMENT REQUIRED. (a) If a parent eligible
3-3 for dependent health coverage through an insurer is required by a
3-4 court or administrative order to provide health coverage for a
3-5 child, the insurer shall permit the parent to enroll the child
3-6 without regard to any enrollment period restriction.
3-7 (b) If a parent eligible for dependent health coverage
3-8 through an insurer is required by a court or administrative order
3-9 to provide health coverage for a child and fails to apply to obtain
3-10 the health insurance coverage for the child, the insurer shall
3-11 enroll the child on application of a custodial parent of the child,
3-12 a child support agency having a duty to collect or enforce support
3-13 for the child, or the child.
3-14 Art. 3.96-4. CANCELLATION OR NONRENEWAL PROHIBITED. An
3-15 insurer may not cancel or refuse to renew insurance coverage of a
3-16 child entitled to enrollment or enrolled under this subchapter
3-17 unless satisfactory written evidence is filed with the insurer that
3-18 shows that:
3-19 (1) the court order or administrative order that
3-20 required the coverage is no longer in effect; or
3-21 (2) the child is enrolled in comparable health
3-22 insurance coverage or will be enrolled in comparable coverage that
3-23 will take effect not later than the effective date of the
3-24 cancellation or nonrenewal.
3-25 Art. 3.96-5. EFFECT OF ASSIGNMENT OF MEDICAL SUPPORT RIGHTS
3-26 TO STATE AGENCY; INFORMATION. (a) An insurer may not impose
3-27 requirements on a state agency that has been assigned the rights of
4-1 an individual eligible for medical assistance and covered for
4-2 health benefits from the insurer that are different from the
4-3 requirements applicable to an agent or assignee of any other
4-4 covered individual.
4-5 (b) An insurer shall provide to a state agency providing
4-6 medical assistance, or to a child support agency enforcing medical
4-7 support, information as necessary to facilitate reimbursement of
4-8 medical services provided to or paid on behalf of a child.
4-9 Art. 3.96-6. RIGHTS OF CUSTODIAL PARENT AND ADULT CHILD.
4-10 (a) If a child receives health insurance coverage through the
4-11 insurer of a parent of the child, that insurer must provide
4-12 information and documents to each custodial parent or an adult
4-13 child as necessary for the child to obtain benefits through that
4-14 coverage, including:
4-15 (1) the name of the insurer;
4-16 (2) the number of the policy;
4-17 (3) a copy of the policy and schedule of benefits;
4-18 (4) a health insurance membership card;
4-19 (5) claim forms; and
4-20 (6) any other information or document necessary to
4-21 submit a claim in accordance with the insurer's policies and
4-22 procedures.
4-23 (b) The insurer shall permit a custodial parent, a health
4-24 care provider, adult child, or a state agency that has been
4-25 assigned medical support rights to submit claims for covered
4-26 services without the approval of the insured parent.
4-27 (c) The insurer shall make payments on covered claims
5-1 submitted in accordance with this article directly to the custodial
5-2 parent, health care provider, adult child, or state agency making
5-3 the claim.
5-4 Art. 3.96-7. SERVICE AREA RESTRICTIONS PROHIBITED. An
5-5 insurer may not enforce otherwise applicable provisions that would
5-6 deny, limit, or reduce payment for claims for a covered child who
5-7 lives outside the insurer's coverage territory but inside the
5-8 United States.
5-9 Art. 3.96-8. PENALTIES; REMEDIES. An insurer that violates
5-10 this subchapter is subject to the same penalties, and an injured
5-11 party has the same rights and remedies, as those provided by
5-12 Section 16, Article 21.21, of this code.
5-13 Art. 3.96-9. RULES. The commissioner shall adopt reasonable
5-14 rules as necessary to implement this subchapter and the
5-15 requirements of 42 U.S.C. Section 1396a(a)(60), including rules
5-16 defining acts that constitute unfair or deceptive practices under
5-17 Section 13, Article 21.21, of this code.
5-18 SECTION 2. Section 14.061(d), Family Code, is amended to
5-19 read as follows:
5-20 (d) In this section:
5-21 (1) "Health <, "health> insurance" is insurance
5-22 coverage that provides basic health care services, including usual
5-23 physician services, office visits, hospitalization, and laboratory,
5-24 X-ray, or emergency services, and may be provided through a health
5-25 maintenance organization (HMO) or other private or public
5-26 organization.
5-27 (2) "Child support agency" has the meaning assigned by
6-1 Section 14.80, Family Code.
6-2 (3) "Employer" includes, for purposes of enrolling
6-3 dependents in a group health insurance plan, a union, trade
6-4 association, or other organization.
6-5 SECTION 3. Section 14.061(g), Family Code, is amended to
6-6 read as follows:
6-7 (g) The obligee, obligor, or a child support agency <local
6-8 domestic relations office, or attorney general, as specified in the
6-9 order,> may send a <certified> copy of the court order requiring an
6-10 obligee or <the> obligor to provide health insurance coverage for a
6-11 <the> child to the obligee's or obligor's employer <by certified
6-12 mail, return receipt requested, at any time after the rendition of
6-13 the court order. The court order is binding on the employer on
6-14 receipt>.
6-15 SECTION 4. Section 14.061(h), Family Code, is amended to
6-16 read as follows:
6-17 (h) An order to an employer directing that health insurance
6-18 coverage be provided to a child of an employee or member is binding
6-19 on the employer on receipt. If the employee or member is eligible
6-20 for dependent health coverage for the child, the <On receipt of the
6-21 court order the obligor's> employer shall immediately enroll the
6-22 child in a health insurance plan <available to the obligor. If the
6-23 employer is not able to immediately enroll the child, the employer
6-24 shall enroll the child at the next available enrollment period as a
6-25 dependent of the obligor>. If dependent coverage is not available
6-26 to the employee or member through the employer's health insurance
6-27 plan, the employer <shall only be responsible for providing notice
7-1 of this fact as provided by Subsection (j) of this section and> is
7-2 not responsible or otherwise liable for providing that <such>
7-3 coverage, but shall provide notice to the individual or agency
7-4 sending the order in accordance with Subsection (j) of this section
7-5 that dependent coverage is not available.
7-6 SECTION 5. Section 14.061(j), Family Code, is amended to
7-7 read as follows:
7-8 (j) An employer who has received an order under this section
7-9 shall provide to the individual or agency sending the order,
7-10 <obligee, local domestic relations office, or the attorney general,
7-11 as specified in the order, by first class mail and> not later than
7-12 the 30th day after the date the employer receives the <court>
7-13 order, a statement that the child:
7-14 (1) has been enrolled in a health insurance plan; or
7-15 (2) <will be enrolled in a health insurance plan at
7-16 the next available enrollment period and provide the expected date
7-17 of such enrollment; or>
7-18 <(3)> cannot be enrolled in a health insurance plan
7-19 and provide the reason why coverage cannot be provided.
7-20 SECTION 6. Section 14.061(q), Family Code, is amended to
7-21 read as follows:
7-22 (q) Unless an employer has eliminated dependent health
7-23 coverage for all of the employer's employees or members, the
7-24 employer may not cancel or eliminate coverage of a child enrolled
7-25 under this section until the employer is provided satisfactory
7-26 written evidence that:
7-27 (1) the court order or administrative order requiring
8-1 the coverage is no longer in effect; or
8-2 (2) the child is enrolled in comparable health
8-3 insurance coverage or will be enrolled in comparable coverage that
8-4 will take effect not later than the effective date of the
8-5 cancellation or elimination of the employer's coverage <Nothing in
8-6 this section shall be construed to require a health maintenance
8-7 organization to provide coverage to a child who resides outside the
8-8 geographic service area>.
8-9 SECTION 7. Section 14.061(r), Family Code, is amended to
8-10 read as follows:
8-11 (r) Receipt of an <For purposes of enrolling a child in a
8-12 health insurance program under this section, a court> order
8-13 requiring that health insurance be provided for a child is a change
8-14 in the family circumstances of the employee or member, for health
8-15 insurance purposes, <covered person> equivalent to the birth or
8-16 adoption of a child by the employee <covered person>. The <On
8-17 receipt of the medical support order by the employer, the> child
8-18 shall be automatically enrolled for the first 31 days after the
8-19 receipt of the order by the employer on the same terms and
8-20 conditions as apply to any other <a> dependent child. The <On
8-21 receipt of the order by the employer, the> employer shall notify
8-22 the insurer of the automatic enrollment. During the 31-day period,
8-23 the employer and insurer shall complete all necessary forms and
8-24 procedures to make the enrollment permanent, or shall report in
8-25 accordance with this subchapter the reasons the coverage cannot be
8-26 made permanent <policyholder shall apply for coverage for the child
8-27 in accordance with the medical support order>.
9-1 SECTION 8. This Act takes effect September 1, 1995, and
9-2 applies only to an insurance policy or evidence of coverage that is
9-3 delivered, issued for delivery, or renewed on or after January 1,
9-4 1996. A policy or evidence of coverage that is delivered, issued
9-5 for delivery, or renewed before January 1, 1996, is governed by the
9-6 law as it existed immediately before the effective date of this
9-7 Act, and that law is continued in effect for that purpose.
9-8 SECTION 9. The importance of this legislation and the
9-9 crowded condition of the calendars in both houses create an
9-10 emergency and an imperative public necessity that the
9-11 constitutional rule requiring bills to be read on three several
9-12 days in each house be suspended, and this rule is hereby suspended.