75R8238 DLF-F
By Berlanga, Cuellar, Delisi, Glaze, H.B. No. 3
Coleman, et al.
Substitute the following for H.B. No. 3:
By Berlanga C.S.H.B. No. 3
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to establishing the Texas Healthy Kids Corporation to
1-3 increase access to health care for children.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subtitle E, Title 2, Health and Safety Code, is
1-6 amended by adding Chapter 109 to read as follows:
1-7 CHAPTER 109. TEXAS HEALTHY KIDS CORPORATION
1-8 SUBCHAPTER A. GENERAL PROVISIONS
1-9 Sec. 109.001. DEFINITIONS. In this chapter:
1-10 (1) "Board" means the board of directors of the
1-11 corporation.
1-12 (2) "Child" means an individual younger than 18 years
1-13 of age.
1-14 (3) "Corporation" means the Texas Healthy Kids
1-15 Corporation established under this chapter.
1-16 (4) "Eligible coverage provider" means an entity that
1-17 meets the requirements for providing coverage under the program
1-18 established by the corporation under Section 109.061.
1-19 (5) "Executive director" means the executive director
1-20 of the corporation.
1-21 (6) "Program" means the health benefit program
1-22 provided by the corporation under this chapter.
1-23 (7) "Title IV-D agency" means the agency designated to
1-24 serve as the state's Title IV-D agency in accordance with Part D,
2-1 Subchapter IV, Social Security Act (42 U.S.C. Section 651 et seq.).
2-2 Sec. 109.002. TEXAS HEALTHY KIDS FUND. (a) The Texas
2-3 healthy kids fund is a fund outside the state treasury held by the
2-4 Texas Treasury Safekeeping Trust Company. The fund is composed of
2-5 money appropriated to the fund and of money appropriated to or
2-6 deposited in the premium stabilization revolving account
2-7 established under Subchapter E. The comptroller shall transfer to
2-8 the fund money appropriated to the fund from the state treasury.
2-9 (b) The comptroller may invest money in the fund in the same
2-10 manner as the comptroller may invest money in the state treasury.
2-11 (c) The board shall file with the comptroller a verified
2-12 copy of a board resolution that designates the authorized
2-13 representatives of the corporation who have authority to spend
2-14 money in the fund.
2-15 Sec. 109.003. BIENNIAL REPORT. Not later than January 1 of
2-16 each odd-numbered year, the corporation shall submit a written
2-17 report to the governor, the lieutenant governor, the speaker of the
2-18 house of representatives, and the commissioner of insurance. The
2-19 report must state the program's status and must include a statement
2-20 of the corporation's financial condition and an accounting for the
2-21 corporation's administrative expenses for the two years preceding
2-22 the date of the report.
2-23 Sec. 109.004. IMMUNITY FROM LIABILITY. Chapter 84, Civil
2-24 Practice and Remedies Code, applies to the corporation and an
2-25 employee or volunteer of the corporation.
2-26 (Sections 109.005-109.030 reserved for expansion)
3-1 SUBCHAPTER B. CORPORATE STRUCTURE
3-2 Sec. 109.031. TEXAS HEALTHY KIDS CORPORATION. (a) The
3-3 Texas Healthy Kids Corporation is created and has the powers that
3-4 are necessary and proper to carry out its duties. The corporation
3-5 is a nonprofit corporation and shall comply with the Texas
3-6 Non-Profit Corporation Act (Article 1396-1.01 et seq., Vernon's
3-7 Texas Civil Statutes).
3-8 (b) The corporation is not subject to the franchise tax
3-9 imposed by Chapter 171, Tax Code.
3-10 (c) Subject to this chapter, the board shall take any step
3-11 necessary to maintain an exemption from federal income tax under
3-12 Section 501(a) of the Internal Revenue Code of 1986 (26 U.S.C.
3-13 Section 501(a)) by being listed as an exempt organization under
3-14 Section 501(c)(3) or 501(c)(4) of that code (26 U.S.C. Section
3-15 501(c)(3) or (c)(4)) or another similar law.
3-16 Sec. 109.032. BOARD OF DIRECTORS; PRESIDING OFFICER. (a)
3-17 The corporation shall operate subject to the general supervision of
3-18 a board of directors. Notwithstanding the Texas Non-Profit
3-19 Corporation Act (Article 1396-1.01 et seq., Vernon's Texas Civil
3-20 Statutes), the board is composed of:
3-21 (1) six members appointed by the governor with the
3-22 advice and consent of the senate;
3-23 (2) the commissioner of health and human services or
3-24 the commissioner's designee, who serves as a nonvoting ex officio
3-25 member;
3-26 (3) the commissioner of insurance or the
3-27 commissioner's designee, who serves as a nonvoting ex officio
4-1 member; and
4-2 (4) the director of the Title IV-D agency, or the
4-3 director's designee, who serves as a nonvoting ex officio member.
4-4 (b) Notwithstanding the Texas Non-Profit Corporation Act
4-5 (Article 1396-1.01 et seq., Vernon's Texas Civil Statutes), the
4-6 appointed members of the board serve staggered six-year terms. The
4-7 terms of two appointed members expire on February 1 of each
4-8 odd-numbered year.
4-9 (c) The members of the board appointed by the governor shall
4-10 annually elect a member appointed by the governor to serve as the
4-11 presiding officer of the board.
4-12 (d) A member of the board may not serve more than two terms,
4-13 without regard to whether the terms are consecutive.
4-14 (e) Members of the board serve without compensation, but are
4-15 entitled to reimbursement of their travel expenses as provided for
4-16 in the General Appropriations Act for state board or commission
4-17 members. Money appropriated to the Texas Department of Insurance,
4-18 the Health and Human Services Commission, or the Title IV-D agency
4-19 may be spent, consistent with the General Appropriations Act, in
4-20 connection with the work or expenses of the ex officio members of
4-21 the board.
4-22 (f) A person is not eligible for appointment to the board if
4-23 the person or the person's spouse is employed by, represents in any
4-24 capacity, owns, or controls any ownership interest in a business or
4-25 organization:
4-26 (1) that may obtain a pecuniary or other favorable
4-27 interest in the course of a business activity with the corporation;
5-1 or
5-2 (2) from whom the corporation receives funds.
5-3 (g) A person is not eligible for appointment to the board if
5-4 the person is or has been an adverse party in litigation against
5-5 the board or corporation.
5-6 Sec. 109.033. POWERS AND DUTIES OF BOARD; OVERSIGHT OF
5-7 COMMISSIONER OF INSURANCE. (a) Subject to Subsection (d), the
5-8 board is the oversight and governing entity of the corporation and
5-9 has any power necessary and proper to carry out its duties under
5-10 this chapter, including the power to adopt bylaws governing the
5-11 operations of the board and the corporation. The board has complete
5-12 fiscal control over the corporation and is responsible for all
5-13 corporate operations.
5-14 (b) The board may request and accept grants and gifts of
5-15 money, property, or services. Subject to Subsection (c), the
5-16 corporation may use a grant or gift for any purpose of the
5-17 corporation, including paying the corporation's business expenses
5-18 and the salaries or wages of the corporation's employees.
5-19 (c) The corporation may use a donation made as community
5-20 benefits by a hospital or hospital system under Section 171.063(a),
5-21 Tax Code, only to purchase health benefits for children who:
5-22 (1) have a family income of less than 200 percent of
5-23 poverty level according to the poverty index prepared by the
5-24 federal Office of Management and Budget; and
5-25 (2) reside:
5-26 (A) in the case of a hospital, in the county in
5-27 which the hospital is located or a county contiguous to the county;
6-1 or
6-2 (B) in the case of a hospital system, in a
6-3 county in which the hospital system operates or any county
6-4 contiguous to a county in which the hospital system operates.
6-5 (d) The board shall submit to the commissioner of insurance
6-6 for approval and may not implement before receiving that approval:
6-7 (1) the corporation's bylaws, plan of operation, and
6-8 any other standards adopted by the board; and
6-9 (2) the health benefit program and health benefit
6-10 plans established by the corporation under Subchapter C.
6-11 Sec. 109.034. EXECUTIVE DIRECTOR. (a) The board shall
6-12 employ an executive director to help the board perform its duties.
6-13 The executive director shall act on behalf of and subject to
6-14 authorization and supervision of the board to carry out the
6-15 purposes of the corporation.
6-16 (b) The corporation shall pay the executive director a
6-17 salary in an amount established by the board.
6-18 (c) The executive director must make and file a surety bond
6-19 in an amount determined by the board for the faithful performance
6-20 of the executive director's duties and the proper safekeeping and
6-21 disbursement of corporate money.
6-22 Sec. 109.035. EMPLOYEES; CONSULTANTS. The executive
6-23 director may employ employees and retain consultants as necessary
6-24 to administer the programs of the corporation.
6-25 Sec. 109.036. PUBLIC INPUT. The board shall develop and
6-26 implement policies that provide the public with a reasonable
6-27 opportunity to appear before the board and to speak on any issue
7-1 related to the corporation or the program.
7-2 Sec. 109.037. OPEN MEETINGS; OPEN RECORDS. The board and
7-3 the corporation are subject to the open meetings law, Chapter 551,
7-4 Government Code, and the open records law, Chapter 552, Government
7-5 Code, subject to Section 109.064.
7-6 Sec. 109.038. COOPERATION OF AND ASSISTANCE TO STATE
7-7 AGENCIES. (a) A health and human services agency, as that term is
7-8 defined by Section 531.001, Government Code, the Texas Department
7-9 of Insurance, the Title IV-D agency, and the comptroller shall
7-10 cooperate with the corporation to assist the corporation in
7-11 performing its duties.
7-12 (b) The corporation shall work with the Title IV-D agency,
7-13 the Texas Department of Human Services, and the Texas Department of
7-14 Health to facilitate the electronic exchange of information among
7-15 the corporation and the agencies that relates to individuals who:
7-16 (1) are covered under the program; and
7-17 (2) are the subject of a medical child support order
7-18 or are or may be eligible for benefits under a federally or
7-19 state-funded program administered by the Texas Department of Human
7-20 Services or the Texas Department of Health.
7-21 Sec. 109.039. AUDIT BY STATE AUDITOR. The corporation is
7-22 subject to audit by the state auditor under Chapter 321, Government
7-23 Code. The audit may include a financial audit and an economy and
7-24 efficiency audit.
7-25 (Sections 109.040-109.060 reserved for expansion
7-26 SUBCHAPTER C. HEALTH BENEFIT PROGRAM
7-27 Sec. 109.061. HEALTH BENEFIT PROGRAM. (a) The corporation
8-1 shall:
8-2 (1) establish a program to provide, through eligible
8-3 coverage providers, health benefits for eligible children in this
8-4 state who:
8-5 (A) are not covered by insurance or another type
8-6 of health benefit plan;
8-7 (B) are not covered by insurance or another type
8-8 of health benefit plan for a specified medical condition; or
8-9 (C) are not covered by insurance or another type
8-10 of health benefit plan that, in the opinion of the board, provides
8-11 adequate coverage;
8-12 (2) develop the design and benefits structure of the
8-13 health benefit program offered by the corporation through eligible
8-14 coverage providers;
8-15 (3) determine eligibility criteria that children and
8-16 their family members must meet before the children may participate
8-17 in the program;
8-18 (4) develop participation criteria, subject to Section
8-19 109.063, for authorized insurers, health service organizations,
8-20 health maintenance organizations, and other entities eligible to
8-21 provide coverage under the health benefit program;
8-22 (5) develop and implement a public awareness program
8-23 to educate the public about the program;
8-24 (6) establish participation objectives for the
8-25 program;
8-26 (7) negotiate premiums for coverage under the program
8-27 and applicable copayments, coinsurance, or deductibles to be paid
9-1 on behalf of a covered child; and
9-2 (8) contract for the provision of health benefit
9-3 coverage under the program.
9-4 (b) The board may contract for or otherwise obtain
9-5 third-party administration services for the corporation.
9-6 (c) In developing the program, the corporation may consult
9-7 with the Texas Department of Health, appropriate professional
9-8 organizations, coverage providers, other agency officials, and
9-9 consultants. The corporation shall consult with the Title IV-D
9-10 agency in matters relating to coverage for children who are the
9-11 subject of a medical child support order and for whom the agency is
9-12 providing enforcement services.
9-13 (d) Notwithstanding Article 3.51-6, Insurance Code, the
9-14 corporation may establish group coverage plans for children under
9-15 the program in specified geographic regions of the state or based
9-16 on other criteria approved by the commissioner of insurance.
9-17 (e) The parent, managing conservator, or guardian of a
9-18 child, or another person sponsoring coverage for the child, is
9-19 responsible for premiums for coverage under the program and for
9-20 applicable copayments, coinsurance, or deductibles, as determined
9-21 by the corporation. The corporation may develop a premium
9-22 structure that varies according to ability to pay and may require,
9-23 in accordance with the premium structure, that the parent,
9-24 conservator, guardian, or sponsor pay the full cost of the child's
9-25 coverage.
9-26 (f) The corporation may require that the parent, managing
9-27 conservator, or guardian of a child, or another person sponsoring
10-1 coverage for the child, pay to the corporation a reasonable
10-2 enrollment fee, in an amount set by the corporation, before the
10-3 child is enrolled in coverage under the program.
10-4 (g) The health benefit coverage provided under the
10-5 corporation's program is secondary to any other available private
10-6 coverage covering a child. The corporation shall ensure that
10-7 benefits provided by the program are the payor of last resort with
10-8 respect to private coverage covering a child.
10-9 (h) In developing eligibility criteria under Subsection
10-10 (a)(3), the corporation may consider the impact of the eligibility
10-11 criteria on the availability of other health benefit plan coverage
10-12 for children. The corporation may restrict eligibility for coverage
10-13 under the program or impose a waiting period or other appropriate
10-14 restriction to minimize any adverse impact on the availability of
10-15 other health benefit plan coverage.
10-16 (i) The board may develop a marketing plan under which each
10-17 participating eligible coverage provider is required to market the
10-18 program. The corporation or eligible coverage providers may
10-19 publicize the corporation and the general nature of the program.
10-20 Direct sale or solicitation of a health benefit plan offered
10-21 through the program must be done in accordance with the Insurance
10-22 Code and other insurance laws of this state.
10-23 Sec. 109.062. CORPORATE OPERATIONS; LICENSING REQUIREMENTS.
10-24 (a) The corporation is not an insurer and may not self-insure or
10-25 self-fund the coverage provided through the program. The board and
10-26 employees of the corporation are not agents of an insurer. The
10-27 corporation, the board, and the employees of the corporation are
11-1 not subject to any licensing requirement imposed under the
11-2 Insurance Code or another insurance law of this state.
11-3 (b) The corporation shall use prudent business practices in
11-4 the procurement of goods and services. A law governing the
11-5 procurement of goods or services by a state agency, including
11-6 Chapter 2054 or 2254, Government Code, or Subtitle D, Title 10,
11-7 Government Code, does not apply to the procurement of goods or
11-8 services by the corporation. This subsection applies without
11-9 regard to whether the goods or services are procured with money
11-10 provided to the corporation under a state grant or under
11-11 appropriation.
11-12 Sec. 109.063. OPERATIONS OF ELIGIBLE COVERAGE PROVIDER. (a)
11-13 An eligible coverage provider must:
11-14 (1) hold a certificate of authority or other
11-15 appropriate license issued by the Texas Department of Insurance
11-16 that authorizes the eligible coverage provider to provide the type
11-17 of coverage to be offered through the program; and
11-18 (2) satisfy, except as provided by this section, any
11-19 other applicable requirement of the Insurance Code or another
11-20 insurance law of this state.
11-21 (b) A health benefit plan provider under the program is not
11-22 subject to a law that requires coverage or the offer of coverage of
11-23 a health care service or benefit.
11-24 (c) An eligible coverage provider is not subject to the
11-25 premium tax imposed by Article 4.11, Insurance Code, or the tax on
11-26 revenues imposed under Section 33, Texas Health Maintenance
11-27 Organization Act (Section 20A.33, Vernon's Texas Insurance Code),
12-1 with respect to money received for coverage provided under this
12-2 chapter.
12-3 Sec. 109.064. ACCESS TO RECORDS; CONFIDENTIALITY. (a)
12-4 Notwithstanding any other law, the corporation may obtain the
12-5 medical records of and other information relating to a child
12-6 covered by the program or applying to be covered by the program on
12-7 receipt of the informed written consent of the child's parent,
12-8 managing conservator, or guardian.
12-9 (b) Information in the possession of the corporation that
12-10 identifies an individual, including medical records and family
12-11 financial information, is confidential and exempt from disclosure
12-12 and discovery in a civil action. Subject to Section 109.038(b) and
12-13 any requirement of federal law, the corporation or an employee or
12-14 agent of the corporation may not release confidential information
12-15 to any person, including a state or federal agency, without the
12-16 written consent of a parent, managing conservator, or guardian of
12-17 the participating child.
12-18 Sec. 109.065. GRIEVANCES AND APPEALS. The corporation shall
12-19 develop a plan for the receipt and consideration of complaints
12-20 regarding participating eligible coverage providers to ensure
12-21 appropriate delivery of health care services to participating
12-22 children and to ensure that eligible coverage providers comply with
12-23 any applicable complaint procedure imposed by law or the
12-24 requirements of the corporation.
12-25 Sec. 109.066. TEXAS DEPARTMENT OF HEALTH PROGRAMS. (a) The
12-26 department may use appropriated funds, in accordance with the
12-27 General Appropriations Act, to purchase coverage under a health
13-1 benefit plan provided through the program for children who are
13-2 eligible for coverage for the program if:
13-3 (1) the children receive health care benefits under
13-4 the chronically ill and disabled children's program or another
13-5 federally funded or state-funded program, other than the state
13-6 Medicaid program, that is administered by the department;
13-7 (2) provision of the benefits through a health benefit
13-8 plan provided through the program is a more cost-effective means of
13-9 providing some or all of the benefits described by Subdivision (1);
13-10 and
13-11 (3) no benefit or service provided to the children is
13-12 eliminated or adversely affected as a result of the provision of
13-13 the benefits through the program.
13-14 (b) Services provided to children under a federally funded
13-15 or state-funded program administered by the department, including
13-16 the chronically ill and disabled children's program, may not be
13-17 reduced or eliminated because some or all of the services are
13-18 provided through the program or otherwise provided because of the
13-19 establishment of the corporation or the program.
13-20 (Sections 109.067-109.100 reserved for expansion
13-21 SUBCHAPTER D. COVERAGE UNDER ORDER OF MEDICAL
13-22 SUPPORT FOR CHILD
13-23 Sec. 109.101. APPLICATION. A party ordered under Chapter
13-24 154, Family Code, to apply for coverage for a child under the
13-25 program shall provide to the corporation:
13-26 (1) a copy of the order rendered under Chapter 154;
13-27 and
14-1 (2) the name and address of the obligor's employer.
14-2 Sec. 109.102. DUTIES OF CORPORATION OR DESIGNEE OF
14-3 CORPORATION. (a) The corporation or the designee of the
14-4 corporation shall review an application and, if the corporation or
14-5 designee finds that the child is eligible for coverage under the
14-6 program, shall:
14-7 (1) issue coverage to the child in accordance with the
14-8 program; and
14-9 (2) notify the obligor's employer in accordance with
14-10 Subsection (b).
14-11 (b) The notice provided under Subsection (a)(2) must:
14-12 (1) explain the employer's obligations under Section
14-13 109.103;
14-14 (2) state:
14-15 (A) the amount to be paid for coverage of the
14-16 child, including the amount of the premium and the premium
14-17 stabilization revolving account fee imposed under Subchapter E;
14-18 (B) whether the amount is to be paid to the
14-19 corporation or the corporation's designee; and
14-20 (C) the address to which the payment is to be
14-21 sent; and
14-22 (3) include a copy of the medical child support order
14-23 rendered under Chapter 154, Family Code.
14-24 (c) The corporation or the corporation's designee shall
14-25 notify the employer of an obligor of any increase in the amount to
14-26 be paid for coverage of the child under the program.
14-27 Sec. 109.103. DUTY OF EMPLOYER. (a) An employer who
15-1 receives notice under Section 109.102 shall withhold an appropriate
15-2 amount from the obligor's earnings for the required payment and
15-3 remit the amount as instructed on the notice.
15-4 (b) An employer who fails to withhold or remit payments as
15-5 required by this section or who discriminates in hiring or
15-6 employment on the basis of a medical support order is subject to
15-7 the penalties and fines imposed under Subchapter C, Chapter 158,
15-8 Family Code.
15-9 (Sections 109.104-109.150 reserved for expansion
15-10 SUBCHAPTER E. ELIGIBILITY OF CERTAIN CHILDREN;
15-11 STABILIZATION FUND
15-12 Sec. 109.151. TERMINATION FOR FAILURE TO PAY PREMIUMS.
15-13 Except as provided by this subchapter, the corporation shall
15-14 terminate the coverage of a child for failure to pay a premium as
15-15 required under Section 109.061(e).
15-16 Sec. 109.152. PREMIUM STABILIZATION REVOLVING ACCOUNT.
15-17 (a) The premium stabilization revolving account is an account
15-18 within the Texas healthy kids fund.
15-19 (b) The premium stabilization revolving account is composed
15-20 of money contributed to the account under this subchapter, any
15-21 money appropriated to the account by the legislature, and any gift
15-22 of money accepted by the board for the purposes of the account.
15-23 Sec. 109.153. FEE; DEPOSIT TO ACCOUNT. (a) The corporation
15-24 shall charge for each child covered under the program a reasonable
15-25 premium stabilization revolving account fee, not to exceed $5 each
15-26 month.
15-27 (b) The corporation shall remit money collected under this
16-1 section to the comptroller, in accordance with rules adopted by the
16-2 comptroller, for deposit to the credit of the premium stabilization
16-3 revolving account.
16-4 Sec. 109.154. USE OF MONEY IN ACCOUNT. (a) Money in the
16-5 premium stabilization revolving account may be used by the
16-6 corporation only to pay a premium for coverage provided through the
16-7 program for a child for whom a premium is not paid in accordance
16-8 with Section 109.061(e).
16-9 (b) A premium may not be paid for a child who is covered by
16-10 a health benefit plan other than the plan offered by the
16-11 corporation.
16-12 (c) The corporation shall determine the period for which
16-13 premiums may be paid from the fund and the circumstances under
16-14 which the premiums may be paid.
16-15 (d) The parent, managing conservator, or guardian of a child
16-16 for whom a premium is paid from the premium stabilization revolving
16-17 account, or another person sponsoring coverage for the child,
16-18 remains responsible for reimbursing the account for the premium
16-19 paid. The coverage for the child is subject to termination, in
16-20 accordance with criteria adopted by the board, if the parent,
16-21 managing conservator, guardian, or sponsor fails to reimburse the
16-22 account as required by this subsection. The corporation shall
16-23 remit money collected under this subsection to the comptroller for
16-24 deposit to the credit of the account.
16-25 SECTION 2. Section 154.182, Family Code, is amended by
16-26 amending Subsection (b) and adding Subsection (c) to read as
16-27 follows:
17-1 (b) In determining the manner in which health insurance for
17-2 the child is to be ordered, the court shall render its order in
17-3 accordance with the following priorities, unless a party shows good
17-4 cause why a particular order would not be in the best interest of
17-5 the child:
17-6 (1) if health insurance is available for the child
17-7 through the obligor's employment or membership in a union, trade
17-8 association, or other organization, the court shall order the
17-9 obligor to include the child in the obligor's health insurance;
17-10 (2) if health insurance is not available for the child
17-11 through the obligor's employment but is available for the child
17-12 through the obligee's employment or membership in a union, trade
17-13 association, or other organization, the court may order the obligee
17-14 to provide health insurance for the child, and, in such event,
17-15 shall order the obligor to pay additional child support to be
17-16 withheld from earnings under Chapter 158 to the obligee for the
17-17 actual cost of the health insurance for the child; [or]
17-18 (3) if health insurance is not available for the child
17-19 under Subdivision (1) or (2), the court shall order the obligor to
17-20 provide health insurance for the child if the court finds that
17-21 health insurance is available for the child from another source and
17-22 that the obligor is financially able to provide it;
17-23 (4) if health insurance is not available for the child
17-24 under Subdivision (1), (2), or (3), the court shall order the
17-25 obligor to apply for coverage through the Texas Healthy Kids
17-26 Corporation established under Chapter 109, Health and Safety Code;
17-27 or
18-1 (5) if health coverage is not available for the child
18-2 under Subdivision (1), (2), (3), or (4), the court shall order the
18-3 obligor to pay the obligee, in addition to any amount ordered under
18-4 the guidelines for child support, a reasonable amount each month as
18-5 medical support for the child to be withheld from earnings under
18-6 Chapter 158.
18-7 (c) In establishing the amount of additional medical child
18-8 support under Subsection (b)(5), the court shall presume that $38
18-9 each month is a reasonable amount for a child but may order a
18-10 greater or lesser amount as appropriate under the circumstances.
18-11 The Health and Human Services Commission may promulgate guidelines
18-12 for the dollar amounts of medical child support that the court may
18-13 presumptively apply in circumstances in which the obligor is
18-14 responsible for medical child support for more than one child.
18-15 SECTION 3. Section 171.063(a), Tax Code, is amended to read
18-16 as follows:
18-17 (a) The following corporations are exempt from the franchise
18-18 tax:
18-19 (1) a nonprofit corporation exempted from the federal
18-20 income tax under Section 501(c)(3), (4), (5), (6), (7), (8), (10),
18-21 or (19), Internal Revenue Code which in the case of a nonprofit
18-22 hospital means a hospital providing charity care and community
18-23 benefits as set forth in Paragraph (A), (B), (C), (D), (E), (F), or
18-24 (G):
18-25 (A) charity care and government-sponsored
18-26 indigent health care are provided at a level which is reasonable in
18-27 relation to the community needs, as determined through the
19-1 community needs assessment, the available resources of the hospital
19-2 or hospital system, and the tax-exempt benefits received by the
19-3 hospital or hospital system;
19-4 (B) charity care and government-sponsored
19-5 indigent health care are provided in an amount equal to at least
19-6 four percent of the hospital's or hospital system's net patient
19-7 revenue;
19-8 (C) charity care and government-sponsored
19-9 indigent health care are provided in an amount equal to at least
19-10 100 percent of the hospital's or hospital system's tax-exempt
19-11 benefits, excluding federal income tax;
19-12 (D) for tax periods beginning before January 1,
19-13 1996, charity care and community benefits are provided in a
19-14 combined amount equal to at least five percent of the hospital's
19-15 net patient revenue, provided that charity care and
19-16 government-sponsored indigent health care are provided in an amount
19-17 equal to at least three percent of net patient revenue;
19-18 (E) for tax periods beginning after December 31,
19-19 1995, charity care and community benefits are provided in a
19-20 combined amount equal to at least five percent of the hospital's or
19-21 hospital system's net patient revenue, provided that charity care
19-22 and government-sponsored indigent health care are provided in an
19-23 amount equal to at least four percent of net patient revenue;
19-24 (F) a nonprofit hospital that has been
19-25 designated as a disproportionate share hospital under the state
19-26 Medicaid program in the current year or in either of the previous
19-27 two fiscal years is considered to have provided a reasonable amount
20-1 of charity care and government-sponsored indigent health care and
20-2 is considered in compliance with the standards provided by this
20-3 subsection; or
20-4 (G) a hospital operated on a nonprofit basis
20-5 that is located in a county with a population of less than 50,000
20-6 and in which the entire county or the population of the entire
20-7 county has been designated as a health professionals shortage area
20-8 is considered in compliance with the standards provided by this
20-9 subsection;
20-10 (2) a corporation exempted under Section 501(c)(2) or
20-11 (25), Internal Revenue Code, if the corporation or corporations for
20-12 which it holds title to property is either exempt from or not
20-13 subject to the franchise tax;
20-14 (3) a corporation exempted from federal income tax
20-15 under Section 501(c)(16), Internal Revenue Code; and
20-16 (4) a nonprofit corporation exempted from the federal
20-17 income tax under Section 501(c)(3), Internal Revenue Code, that
20-18 does not receive any payment for providing health care services to
20-19 inpatients or outpatients from any source including but not limited
20-20 to the patient or person legally obligated to support the patient,
20-21 third-party payors, Medicare, Medicaid, or any other state or local
20-22 indigent care program. Payment for providing health care services
20-23 does not include charitable donations, legacies, bequests, or
20-24 grants or payments for research.
20-25 For purposes of satisfying Paragraph (E) of Subdivision (1),
20-26 a hospital or hospital system may not change its existing fiscal
20-27 year unless the hospital or hospital system changes its ownership
21-1 or corporate structure as a result of a sale or merger.
21-2 For purposes of this subsection, a hospital that satisfies
21-3 Paragraph (A), (F), or (G) of Subdivision (1) shall be excluded in
21-4 determining a hospital system's compliance with the standards
21-5 provided by Paragraph (B), (C), (D), or (E) of Subdivision (1).
21-6 For purposes of this subsection, the terms "charity care,"
21-7 "government-sponsored indigent health care," "health care
21-8 organization," "hospital system," "net patient revenue," "nonprofit
21-9 hospital," and "tax-exempt benefits" have the meanings set forth in
21-10 Sections 311.031 and 311.042, Health and Safety Code. A
21-11 determination of the amount of community benefits and charity care
21-12 and government-sponsored indigent health care provided by a
21-13 hospital or hospital system and the hospital's or hospital system's
21-14 compliance with the requirements of Section 311.045, Health and
21-15 Safety Code, shall be based on the most recently completed and
21-16 audited prior fiscal year of the hospital or hospital system.
21-17 For purposes of this subsection, "community benefits"
21-18 includes a donation of money to the Texas Healthy Kids Corporation
21-19 established by Chapter 109, Health and Safety Code, to be used for
21-20 a purpose described by Section 109.033(c), Health and Safety Code.
21-21 The providing of charity care and government-sponsored
21-22 indigent health care in accordance with Paragraph (A) of
21-23 Subdivision (1) shall be guided by the prudent business judgment of
21-24 the hospital which will ultimately determine the appropriate level
21-25 of charity care and government-sponsored indigent health care based
21-26 on the community needs, the available resources of the hospital,
21-27 the tax-exempt benefits received by the hospital, and other factors
22-1 that may be unique to the hospital, such as the hospital's volume
22-2 of Medicare and Medicaid patients. These criteria shall not be
22-3 determinative factors, but shall be guidelines contributing to the
22-4 hospital's decision along with other factors which may be unique to
22-5 the hospital. The formulas contained in Paragraphs (B), (C), (D),
22-6 and (E) of Subdivision (1) shall also not be considered
22-7 determinative of a reasonable amount of charity care and
22-8 government-sponsored indigent health care.
22-9 The requirements of this subsection shall not apply to the
22-10 extent a hospital or hospital system demonstrates that reductions
22-11 in the amount of community benefits, charity care, and
22-12 government-sponsored indigent health care are necessary to maintain
22-13 financial reserves at a level required by a bond covenant, are
22-14 necessary to prevent the hospital or hospital system from
22-15 endangering its ability to continue operations, or if the hospital,
22-16 as a result of a natural or other disaster, is required
22-17 substantially to curtail its operations.
22-18 In any fiscal year that a hospital or hospital system,
22-19 through unintended miscalculation, fails to meet any of the
22-20 standards in Subdivision (1), the hospital or hospital system shall
22-21 not lose its tax-exempt status without the opportunity to cure the
22-22 miscalculation in the fiscal year following the fiscal year the
22-23 failure is discovered by both meeting one of the standards and
22-24 providing an additional amount of charity care and
22-25 government-sponsored indigent health care that is equal to the
22-26 shortfall from the previous fiscal year. A hospital or hospital
22-27 system may apply this provision only once every five years.
23-1 SECTION 4. As soon as practicable after the effective date
23-2 of this Act, the governor shall appoint the initial board of
23-3 directors of the Texas Healthy Kids Corporation. In appointing the
23-4 initial board of directors, the governor shall appoint two persons
23-5 to terms expiring on February 1, 1999, two persons to terms
23-6 expiring on February 1, 2001, and two persons to terms expiring on
23-7 February 1, 2003.
23-8 SECTION 5. (a) Not later than the 60th day after the
23-9 effective date of this Act, the commissioner of insurance, acting
23-10 as incorporator, shall take the steps necessary to create the Texas
23-11 Healthy Kids Corporation as a nonprofit corporation under the Texas
23-12 Non-Profit Corporation Act (Article 1396-1.01 et seq., Vernon's
23-13 Texas Civil Statutes).
23-14 (b) Not later than the 90th day after the effective date of
23-15 this Act, the commissioner of insurance, acting on behalf of the
23-16 Texas Healthy Kids Corporation, shall employ an acting executive
23-17 director for the corporation. The acting executive director may:
23-18 (1) develop a proposed business plan for the
23-19 corporation;
23-20 (2) solicit alternative funding for the corporation
23-21 and for the health benefit plan program to be established by the
23-22 corporation; and
23-23 (3) develop, to the extent possible, a proposed health
23-24 benefit plan program for the consideration of the board of
23-25 directors of the Texas Healthy Kids Corporation.
23-26 (c) The commissioner of insurance, on behalf of the
23-27 corporation, may accept grants and gifts of money, property, or
24-1 services to assist the acting executive director appointed under
24-2 Subsection (b) of this section in carrying out the acting executive
24-3 director's powers. The commissioner's authority under this section
24-4 expires on the date all of the appointed members of the board of
24-5 directors of the Texas Healthy Kids Corporation have been appointed
24-6 by the governor and have qualified for office.
24-7 (d) The acting executive director appointed under this
24-8 section serves until the earlier of:
24-9 (1) the date the acting executive director is
24-10 dismissed by the commissioner of insurance;
24-11 (2) the date the acting executive director is
24-12 dismissed by the board of directors of the Texas Healthy Kids
24-13 Corporation; or
24-14 (3) the date the board of directors of the corporation
24-15 employs an executive director for the corporation.
24-16 (e) Notwithstanding Subsection (b) of this section, the
24-17 commissioner of insurance may not employ an acting executive
24-18 director on or after the date all of the appointed members of the
24-19 board of directors of the Texas Healthy Kids Corporation have been
24-20 appointed and have qualified for office.
24-21 SECTION 6. (a) The Texas Healthy Kids Corporation shall
24-22 offer a health benefit plan under Chapter 109, Health and Safety
24-23 Code, as added by this Act, not later than the first anniversary of
24-24 the effective date of this Act.
24-25 (b) Not later than the date the Texas Healthy Kids
24-26 Corporation first offers a health benefit plan in accordance with
24-27 Subsection (a) of this section, the board of directors of the Texas
25-1 Healthy Kids Corporation shall:
25-2 (1) establish general administrative and accounting
25-3 procedures for the corporation;
25-4 (2) develop the design and benefits structure of any
25-5 health benefit plan that may be offered by the corporation through
25-6 eligible coverage providers in accordance with Chapter 109, Health
25-7 and Safety Code, as added by this Act; and
25-8 (3) develop a plan for the receipt and consideration
25-9 of complaints as required by Section 109.065, Health and Safety
25-10 Code, as added by this Act.
25-11 (c) The board of directors of the Texas Healthy Kids
25-12 Corporation shall determine whether it is feasible, considering the
25-13 resources available, to initially offer the health benefit plan
25-14 required under Chapter 109, Health and Safety Code, as added by
25-15 this Act, in each region of the state. If the board determines
25-16 that it is not feasible to initially offer the health benefit plan
25-17 on a statewide basis, the board shall develop and the corporation
25-18 shall implement a schedule to stagger implementation of the health
25-19 benefit program in different regions of the state.
25-20 SECTION 7. A court may not order that coverage be provided
25-21 to a child through the Texas Healthy Kids Corporation under Section
25-22 154.182, Family Code, as amended by this Act, before the date that
25-23 corporation first offers coverage under a health benefit plan.
25-24 SECTION 8. As soon as practicable after the effective date
25-25 of this Act, the Title IV-D agency shall seek the modification of
25-26 child support orders that are enforced by the agency and to which
25-27 Section 154.182(b)(5), Family Code, as added by this Act, applies
26-1 to obtain additional medical child support under that subdivision.
26-2 SECTION 9. (a) Except as provided by Subsection (b) of this
26-3 section, this Act takes effect immediately.
26-4 (b) Section 3 of this Act takes effect January 1, 1998, and
26-5 applies to a report originally due on or after that date.
26-6 SECTION 10. The importance of this legislation and the
26-7 crowded condition of the calendars in both houses create an
26-8 emergency and an imperative public necessity that the
26-9 constitutional rule requiring bills to be read on three several
26-10 days in each house be suspended, and this rule is hereby suspended,
26-11 and that this Act take effect and be in force according to its
26-12 terms, and it is so enacted.