By Madden                                       H.B. No. 1368

      75R2762 SAW-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to eligibility for publicly subsidized health care

 1-3     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 applicant's social security number, if

1-12     available;

1-13                 (3)  the number of persons in the applicant's

1-14     household, excluding persons receiving AFDC, SSI, or Medicaid

1-15     benefits;

1-16                 (4)  the applicant's county of residence;

1-17                 (5)  the existence of insurance coverage or other

1-18     hospital or health care benefits for which the applicant is

1-19     eligible;

1-20                 (6)  the name and address of the applicant's employer,

1-21     if the applicant is employed;

1-22                 (7)  if the applicant is employed, whether the

1-23     applicant has rejected comprehensive health care benefits offered

1-24     by the employer at no cost to the applicant;

 2-1                 (8) [(6)]  any transfer of title to real property that

 2-2     the applicant has made in the preceding 24 months;

 2-3                 (9) [(7)]  the applicant's annual household income,

 2-4     excluding the income of any household member receiving AFDC, SSI,

 2-5     or Medicaid benefits;  and

 2-6                 (10) [(8)]  the amount of the applicant's liquid assets

 2-7     and the equity value of the applicant's car and real property.

 2-8           SECTION 2.  Section 61.008, Health and Safety Code, is

 2-9     amended  by adding Subsections (c) and (d) to read as follows:

2-10           (c)  A person or a person's dependent is not an eligible

2-11     county resident or eligible resident if:

2-12                 (1)  an employer offers comprehensive health benefit

2-13     plan coverage for the person or the person's dependent, including

2-14     coverage under:

2-15                       (A)  a group or individual health insurance

2-16     policy or contract;

2-17                       (B)  an evidence of coverage issued by a health

2-18     maintenance organization or group hospital service corporation; or

2-19                       (C)  an employee benefit plan;

2-20                 (2)  the employer would pay the entire cost of the

2-21     health benefit plan coverage for the person or the person's

2-22     dependent; and

2-23                 (3)  the person or the person's dependent does not have

2-24     coverage under the health benefit plan offered by the employer

2-25     because the person refused the coverage.

2-26           (d)  Subsection (c) does not apply to a person or a person's

2-27     dependent who:

 3-1                 (1)  receives emergency services; or

 3-2                 (2)  had coverage under another health benefit plan at

 3-3     the time the person refused the coverage offered by the employer.

 3-4           SECTION 3.  Chapter 285, Health and Safety Code, is amended

 3-5     by adding Subchapter K to read as follows:

 3-6          SUBCHAPTER K.  ELIGIBILITY FOR HOSPITAL DISTRICT SERVICES

 3-7           Sec. 285.201.  CERTAIN PERSONS INELIGIBLE FOR SUBSIDIZED

 3-8     SERVICES.  (a) A hospital district created by general or special

 3-9     law may not provide publicly subsidized health care services to a

3-10     person or a person's dependent if:

3-11                 (1)  an employer offers comprehensive health benefit

3-12     plan coverage for the person or the person's dependent, including

3-13     coverage under:

3-14                       (A)  a group or individual health insurance

3-15     policy or contract;

3-16                       (B)  an evidence of coverage issued by a health

3-17     maintenance organization or group hospital service corporation; or

3-18                       (C)  an employee benefit plan;

3-19                 (2)  the employer would pay the entire cost of the

3-20     health benefit plan coverage for the person or the person's

3-21     dependent; and

3-22                 (3)  the person or the person's dependent does not have

3-23     coverage under the health benefit plan offered by the employer

3-24     because the person refused the coverage.

3-25           (b)  Subsection (a) does not apply to a person or a person's

3-26     dependent who:

3-27                 (1)  receives emergency services; or

 4-1                 (2)  had coverage under another health benefit plan at

 4-2     the time the person refused the coverage offered by the employer.

 4-3           SECTION 4.  Subchapter B, Chapter 32, Human Resources Code,

 4-4     is amended by adding Section 32.0242 to read as follows:

 4-5           Sec. 32.0242.  EMPLOYER PAID HEALTH BENEFIT PLAN COVERAGE.

 4-6     (a)  A person is ineligible for medical assistance, including

 4-7     transitional medical assistance, under this chapter if:

 4-8                 (1)  an employer offers comprehensive health benefit

 4-9     plan coverage for the person or the person's dependent, including

4-10     coverage under:

4-11                       (A)  a group or individual health insurance

4-12     policy or contract;

4-13                       (B)  an evidence of coverage issued by a health

4-14     maintenance organization or group hospital service corporation; or

4-15                       (C)  an employee benefit plan;

4-16                 (2)  the employer would pay the entire cost of the

4-17     health benefit plan coverage for the person or the person's

4-18     dependent; and

4-19                 (3)  the person or the person's dependent does not have

4-20     coverage under the health benefit plan offered by the employer

4-21     because the person refused the coverage.

4-22           (b)  Subsection (a) does not apply to a person or a person's

4-23     dependent who:

4-24                 (1)  receives emergency services; or

4-25                 (2)  had coverage under another health benefit plan at

4-26     the time the person refused the coverage offered by the employer.

4-27           SECTION 5.  If before implementing a provision of this Act

 5-1     the Health and Human Services Commission determines that a waiver

 5-2     or authorization from a federal agency is necessary for

 5-3     implementation, the commission shall request the waiver or

 5-4     authorization and may delay implementing the provision until the

 5-5     waiver or authorization is granted.

 5-6           SECTION 6.  (a)  This Act takes effect September 1, 1997, and

 5-7     applies only to publicly subsidized health care services provided

 5-8     on or after January 1, 1998, regardless of the date on which

 5-9     eligibility for those services is determined.  Publicly subsidized

5-10     health care services provided before that date are governed by the

5-11     law as it existed immediately before the effective date of this

5-12     Act, and that law is continued in effect for that purpose.

5-13           (b)  The Texas Department of Health and the Health and Human

5-14     Services Commission shall adopt rules to implement this Act not

5-15     later than December 31, 1997.

5-16           SECTION 7.  The importance of this legislation and the

5-17     crowded condition of the calendars in both houses create an

5-18     emergency and an imperative public necessity that the

5-19     constitutional rule requiring bills to be read on three several

5-20     days in each house be suspended, and this rule is hereby suspended.