By Madden H.B. No. 317
75R2727 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to eligibility of certain persons for state subsidized
1-3 health care services.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 61.007, Health and Safety Code, is
1-6 amended to read as follows:
1-7 Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The
1-8 department by rule shall require each applicant to provide at least
1-9 the following information:
1-10 (1) the applicant's full name and address;
1-11 (2) the name and address of the applicant's employer,
1-12 if any;
1-13 (3) the applicant's social security number, if
1-14 available;
1-15 (4) [(3)] the number of persons in the applicant's
1-16 household, excluding persons receiving AFDC, SSI, or Medicaid
1-17 benefits;
1-18 (5) [(4)] the applicant's county of residence;
1-19 (6) [(5)] the existence of insurance coverage or other
1-20 hospital or health care benefits for which the applicant is
1-21 eligible;
1-22 (7) [(6)] any transfer of title to real property that
1-23 the applicant has made in the preceding 24 months;
1-24 (8) [(7)] the applicant's annual household income,
2-1 excluding the income of any household member receiving AFDC, SSI,
2-2 or Medicaid benefits; and
2-3 (9) [(8)] the amount of the applicant's liquid assets
2-4 and the equity value of the applicant's car and real property.
2-5 SECTION 2. Section 61.008, Health and Safety Code, is
2-6 amended by adding Subsections (c), (d), (e), and (f) to read as
2-7 follows:
2-8 (c) A person is not an eligible county resident or an
2-9 eligible resident if:
2-10 (1) the person is employed by an employer that offers
2-11 any type of health care coverage for its employees, including
2-12 coverage under:
2-13 (A) a group or individual health insurance
2-14 policy or contract;
2-15 (B) an evidence of coverage issued by a health
2-16 maintenance organization or group hospital service corporation; or
2-17 (C) an employee benefit plan;
2-18 (2) the employer would pay at least 75 percent of the
2-19 cost of the coverage for the employee;
2-20 (3) the person is eligible for coverage that would be
2-21 effective to cover the services for which payment is sought under
2-22 this chapter; and
2-23 (4) the person is not covered under the coverage
2-24 offered by the employer because the person refused that coverage.
2-25 (d) Subsection (c) does not apply to services provided in an
2-26 emergency.
2-27 (e) Subsection (c) does not apply to a person who, at the
3-1 time the person last refused the coverage offered by the employer,
3-2 was covered by health care coverage offered by another employer, an
3-3 employer of a spouse, or otherwise.
3-4 (f) Subsection (c) does not affect the eligibility of a
3-5 dependent of a person who is ineligible under that subsection.
3-6 SECTION 3. Chapter 285, Health and Safety Code, is amended
3-7 by adding Subchapter K to read as follows:
3-8 SUBCHAPTER K. PERSONS ELIGIBLE FOR HOSPITAL DISTRICT SERVICES
3-9 Sec. 285.201. CERTAIN PERSONS INELIGIBLE FOR SERVICES. A
3-10 hospital district created by general or special law may not provide
3-11 services to a person if:
3-12 (1) the person is employed by an employer that offers
3-13 any type of health care coverage for its employees, including
3-14 coverage under:
3-15 (A) a group or individual health insurance
3-16 policy or contract;
3-17 (B) an evidence of coverage issued by a health
3-18 maintenance organization or group hospital service corporation; or
3-19 (C) an employee benefit plan;
3-20 (2) the employer would pay at least 75 percent of the
3-21 cost of the coverage for the employee;
3-22 (3) the person is eligible for coverage that would be
3-23 effective to cover the services; and
3-24 (4) the person is not covered under the coverage
3-25 offered by the employer because the person refused that coverage.
3-26 Sec. 285.202. EXCEPTIONS. (a) Section 285.201 does not
3-27 apply to services provided to a person who:
4-1 (1) is eligible for medical assistance under the state
4-2 Medicaid program;
4-3 (2) pays for the services provided in full; or
4-4 (3) was covered, at the time the person last refused
4-5 the coverage offered by the employer, by health care coverage
4-6 offered by another employer, an employer of a spouse, or otherwise.
4-7 (b) Section 285.201 does not apply to services provided in
4-8 an emergency.
4-9 (c) Section 285.201 does not affect services provided to a
4-10 dependent of a person ineligible for services under that section.
4-11 SECTION 4. The Texas Department of Health shall adopt rules
4-12 as required by Section 61.007, Health and Safety Code, as amended
4-13 by this Act, not later than December 31, 1997.
4-14 SECTION 5. The importance of this legislation and the
4-15 crowded condition of the calendars in both houses create an
4-16 emergency and an imperative public necessity that the
4-17 constitutional rule requiring bills to be read on three several
4-18 days in each house be suspended, and this rule is hereby suspended,
4-19 and that this Act take effect and be in force from and after its
4-20 passage, and it is so enacted.