Amend SB 374 by inserting the following appropriately
numbered ARTICLE and renumbering existing ARTICLES and SECTIONS of
the bill appropriately:
ARTICLE .
CHILDREN WITH SPECIAL HEALTH CARE NEEDS
SECTION ____. Section 35.001, Health and Safety Code, is
amended to read as follows:
Sec. 35.001. SHORT TITLE. This chapter may be cited as the
Children with Special Health Care Needs <Chronically Ill and
Disabled Children's> Services Act.
SECTION ____. Chapter 35, Health and Safety Code, is amended
by adding Sections 35.0021 and 35.0022 to read as follows:
Sec. 35.0021. DEFINITIONS. In this chapter:
(1) "Case management services" includes:
(A) coordinating medical services, marshaling
available assistance, serving as a liaison between the child and
the child's family and caregivers, insurance services, and other
services needed to improve the well-being of the child and the
child's family; and
(B) counseling for the child and the child's
family about measures to prevent the transmission of AIDS or HIV
and the availability in the geographic area of any appropriate
health care services, such as mental health care, psychological
health care, and social and support services.
(2) "Child with special health care needs" has the
meaning assigned by Section 35.0022.
(3) "Dentist" means a person licensed by the State
Board of Dental Examiners to practice dentistry in this state.
(4) "Facility" includes a hospital, an ambulatory
surgical center, and an outpatient clinic.
(5) "Family support services" means support,
resources, or other assistance provided to the family of a child
with special health care needs. The term may include services
described by Part A of the Individuals with Disabilities Education
Act (20 U.S.C. Section 1400 et seq.), as amended, and permanancy
planning, as that term is defined by Section 531.151, Government
Code.
(6) "Other benefit" means a benefit, other than a
benefit provided under this chapter, to which a person is entitled
for payment of the costs of services provided under the program,
including benefits available from:
(A) an insurance policy, group health plan,
health maintenance organization, or prepaid medical or dental care
plan;
(B) Title XVIII, Title XIX, or Title XXI of the
Social Security Act (42 U.S.C. Sections 1395 et seq., 1396 et seq.,
and 1397aa et seq.), as amended;
(C) the Department of Veterans Affairs;
(D) the Civilian Health and Medical Program of
the Uniformed Services;
(E) workers' compensation or any other
compulsory employers' insurance program;
(F) a public program created by federal or state
law or the ordinances or rules of a municipality or other political
subdivision of the state, excluding benefits created by the
establishment of a municipal or county hospital, a joint
municipal-county hospital, a county hospital authority, a hospital
district, or the facilities of a publicly supported medical school;
or
(G) a cause of action for the cost of care,
including medical care, dental care, facility care, and medical
supplies, required for a person applying for or receiving services
from the department, or a settlement or judgment based on the cause
of action, if the expenses are related to the need for services
provided under this chapter.
(7) "Physician" means a person licensed by the Texas
State Board of Medical Examiners to practice medicine in this
state.
(8) "Program" means the services program for children
with special health care needs.
(9) "Provider" means a person who delivers services
purchased by the department for the purposes of this chapter.
(10) "Rehabilitation services" means the process of
the physical restoration, improvement, or maintenance of a body
function destroyed or impaired by congenital defect, disease, or
injury and includes:
(A) facility care, medical and dental care, and
occupational, speech, and physical therapy;
(B) the provision of braces, artificial
appliances, durable medical equipment, and other medical supplies;
and
(C) other types of care specified by the board
in the program rules.
(11) "Services" means the care, activities, and
supplies provided under this chapter or program rules, including
medical care, dental care, facility care, medical supplies,
occupational, physical, and speech therapy, and other care
specified by program rules.
(12) "Specialty center" means a facility and staff
that meet minimum standards established under the program and are
designated by the board for program use in the comprehensive
diagnostic and treatment services for a specific medical condition.
(13) "Support" means to contribute money or services
necessary for a person's maintenance, including food, clothing,
shelter, transportation, and health care.
Sec. 35.0022. CHILD WITH SPECIAL HEALTH CARE NEEDS. (a) In
this chapter, "child with special health care needs" means a person
who:
(1) is younger than 21 years of age and who has a
chronic physical or developmental condition; or
(2) has cystic fibrosis, regardless of the person's
age.
(b) The term "child with special health care needs" may
include a person who has a behavioral or emotional condition that
accompanies the person's physical or developmental condition. The
term does not include a person who has a behavioral or emotional
condition without having an accompanying physical or developmental
condition.
SECTION ____. Section 35.003, Health and Safety Code, is
amended to read as follows:
Sec. 35.003. <CHRONICALLY ILL AND DISABLED CHILDREN'S>
SERVICES PROGRAM FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS. (a)
The program is in the department to provide services to eligible
<chronically ill and disabled> children with special health care
needs. The program shall provide:
(1) early identification of <chronically ill and
disabled> children with special health care needs;
(2) diagnosis and evaluation of <chronically ill and
disabled> children with special health care needs;
(3) rehabilitation services to <chronically ill and
disabled> children with special health care needs;
(4) development and improvement of standards and
services for <chronically ill and disabled> children with special
health care needs; <and>
(5) case management services;
(6) other family support services; and
(7) access to health benefits plan coverage under
Section 35.0031.
(b) The board by rule shall:
(1) specify the type, amount, and duration of services
to be provided under this chapter;
<(2) specify the diseases and conditions covered by
the program;> and
(2) <(3)> permit the payment of insurance premiums for
eligible children.
(c) If budgetary limitations exist, the board by rule shall
establish a system of priorities relating to the types of services
or the classes of persons eligible for the services. A waiting
list of eligible persons may be established if necessary for the
program to remain within the budgetary limitations. The department
shall collect from each applicant for services who is placed on a
waiting list appropriate information to facilitate contacting the
applicant when services become available and to allow efficient
enrollment of the applicant in those services. The information
collected must include:
(1) the applicant's name, address, and phone number;
(2) the name, address, and phone number of a contact
person other than the applicant;
(3) the date of the applicant's earliest application
for services;
(4) the applicant's functional needs;
(5) the range of services needed by the applicant; and
(6) a date on which the applicant is scheduled for
reassessment.
(d) The program may provide:
(1) transportation and subsistence for an eligible
<chronically ill and disabled> child with special health care needs
and the child's parent, managing conservator, guardian, or other
adult caretaker approved by the program to obtain services provided
by the program; and
(2) the following services to an eligible child with
special health care needs <chronically ill and disabled children>
who dies <die> in an approved facility outside the child's
municipality of residence while receiving program services <for a
condition covered by the program>:
(A) the transportation of the child's remains,
and the transportation of a parent or other person accompanying the
remains, from the facility to the place of burial in this state
that is designated by the parent or other person legally
responsible for interment;
(B) the expense of embalming, if required for
transportation;
(C) the cost of a coffin purchased at a minimum
price, if a coffin is required for transportation; and
(D) any other necessary expenses directly
related to the care and return of the child's remains to the place
of burial in this state.
(e) The department may:
(1) develop methods to improve the efficiency and
effectiveness of the program; and
(2) conduct pilot studies<; and>
<(3) provide services only for conditions specified by
this chapter or by the board>.
(f) The program is separate from the financial or medical
assistance program established by Chapters 31 and 32, Human
Resources Code.
SECTION ____. Chapter 35, Health and Safety Code, is amended
by adding Sections 35.0031, 35.0032, 35.0033, 35.0034, and 35.0035
to read as follows:
Sec. 35.0031. HEALTH BENEFITS PLAN COVERAGE FOR CERTAIN
ELIGIBLE CHILDREN. The department shall obtain coverage under a
health benefits plan for a child who:
(1) is eligible for services under this chapter; and
(2) is not eligible for assistance under:
(A) a program established under Title XXI of the
Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended;
or
(B) the medical assistance program under Chapter
32, Human Resources Code.
Sec. 35.0032. BENEFITS COVERAGE REQUIRED. To the extent
possible, the health benefits plan required by Section 35.0031 must
provide benefits comparable to the benefits provided under the
state child health plan established by this state to implement
Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
seq.), as amended.
Sec. 35.0033. HEALTH BENEFITS PLAN PROVIDER. (a) A health
benefits plan provider who provides coverage for benefits under
Section 35.0031 must:
(1) hold a certificate of authority or other
appropriate license issued by the Texas Department of Insurance
that authorizes the health benefits plan provider to provide the
type of coverage to be offered under Section 35.0031; and
(2) satisfy, except as provided by Subsection (b), any
other applicable requirement of the Insurance Code or another
insurance law of this state.
(b) Except as required by the department, a health benefits
plan provider under this chapter is not subject to a law that
requires coverage or the offer of coverage of a health care service
or benefit.
Sec. 35.0034. COST-SHARING PAYMENTS. (a) Except as
provided by Subsection (b), the department may not require a child
who is provided health benefits plan coverage under Section 35.0031
and who meets the income eligibility requirement of the medical
assistance program under Chapter 32, Human Resources Code, to pay a
premium, deductible, coinsurance, or other cost-sharing payment as
a condition of health benefits plan coverage under this chapter.
(b) The department may require a child described by
Subsection (a) to pay a co-payment as a condition of health
benefits plan coverage under Section 35.0031 that is equal to any
co-payment required under the state child health plan established
by this state to implement Title XXI of the Social Security Act (42
U.S.C. Section 1397aa et seq.), as amended.
(c) The department may require a child who is provided
health benefits plan coverage under Section 35.0031 and who meets
the income eligibility requirement of a program established under
Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
seq.), as amended, to pay a premium, deductible, coinsurance, or
other cost-sharing payment as a condition of health benefits plan
coverage. The payment must be equal to any premium, deductible,
coinsurance, or other cost-sharing payment required under the state
child health plan established by this state to implement Title XXI
of the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
amended.
Sec. 35.0035. DISALLOWANCE OF MATCHING FUNDS FROM FEDERAL
GOVERNMENT. Expenditures made to provide health benefits plan
coverage under Section 35.0031 may not be included for the purpose
of determining the state children's health insurance expenditures,
as that term is defined by 42 U.S.C. Section 1397ee(d)(2)(B), as
amended.
SECTION ____. Section 35.004, Health and Safety Code, is
amended by adding Subsection (j) to read as follows:
(j) This section does not apply to services for which
coverage is provided under the health benefits plan established
under Section 35.0031.
SECTION ____. Section 35.005, Health and Safety Code, is
amended to read as follows:
Sec. 35.005. ELIGIBILITY FOR SERVICES. (a) The board by
rule shall:
(1) define medical, financial, and other criteria for
eligibility to receive services; and
(2) establish a system for verifying eligibility
information submitted by an applicant for or recipient of services.
(b) In defining medical and financial criteria for
eligibility under Subsection (a), the board may not:
(1) establish an exclusive list of coverable medical
conditions; or
(2) consider as a source of support to provide
services assets legally owned or available to a child's household.
(c) <(b)> A child is not eligible to receive rehabilitation
services unless:
(1) the child is a resident of this state;
(2) at least one physician or dentist certifies to the
department that the physician or dentist has examined the child and
finds the child to be a <chronically ill and disabled> child with
special health care needs whose disability meets the medical
criteria established by the board;
(3) <the certifying physician or dentist has reason to
expect that services will improve the child's condition or will
extend the child's ability to function independently;>
<(4)> the department determines that the persons who
have any legal obligation to provide services for the child are
unable to pay for the entire cost of the services;
(4) the child has a family income that is less than or
equal to 200 percent of the federal poverty level; and
(5) the child meets all other eligibility criteria
established by board rules.
(d) <(c)> A child is not eligible to receive services, other
than rehabilitation services, unless the child:
(1) is a resident of this state; and
(2) meets all other eligibility criteria established
by board rules.
(e) Notwithstanding Subsection (c)(4), a child with special
health care needs who has a family income that is greater than 200
percent of the federal poverty level and who meets all other
eligibility criteria established by this section and by board rules
is eligible for services if the department determines that the
child's family is or will be responsible for medical expenses that
are equal to or greater than the amount by which the family's
income exceeds 200 percent of the federal poverty level.
SECTION ____. Chapter 35, Health and Safety Code, is amended
by adding Section 35.0061 to read as follows:
Sec. 35.0061. REFERRAL FOR BEHAVIORAL OR EMOTIONAL
CONDITIONS. If a child with special health care needs who is
eligible for services under this chapter has a behavioral or
emotional condition and the child is eligible for services from
another provider of services that would address the behavioral or
emotional condition, the department shall refer the child to that
provider for those services.
SECTION ____. Section 35.007(e), Health and Safety Code, is
amended to read as follows:
(e) The department may collect the cost of services provided
under this chapter directly:
(1) in accordance with <from> Title XVIII, <or> Title
XIX, or Title XXI of the Social Security Act (42 U.S.C. Sections
1395 et seq., <and> 1396 et seq., and 1397aa et seq.), as amended;
or
(2) from any personal insurance, a health maintenance
organization, or any other third party who has a legal obligation
to pay other benefits.
SECTION ____. Sections 35.012(a) and (b), Health and Safety
Code, are amended to read as follows:
(a) The department may take a census, make surveys, and
establish permanent records of <chronically ill and disabled>
children with special health care needs.
(b) The department shall maintain a record of orthotic and
prosthetic devices, durable medical equipment, and medical supplies
purchased by the department for <chronically ill and disabled>
children with special health care needs. Those items are not
state-owned personal property and are exempt from the personal
property inventory requirements of Subtitle D, Title 10, Government
Code.
SECTION ____. The heading of Chapter 35, Health and Safety
Code, is amended to read as follows:
CHAPTER 35. CHILDREN WITH SPECIAL HEALTH CARE NEEDS
<CHRONICALLY ILL AND DISABLED CHILDREN'S SERVICES>
SECTION ____. Section 33.031, Health and Safety Code, is
amended to read as follows:
Sec. 33.031. COORDINATION WITH CHILDREN WITH SPECIAL HEALTH
CARE NEEDS <CHRONICALLY ILL AND DISABLED CHILDREN'S> SERVICES. (a)
All newborn children and other individuals under 21 years of age
who have been screened, have been found to be presumptively
positive through the newborn screening program, and may be
financially eligible may be referred to the department's
<chronically ill and disabled children's> services program for
children with special health care needs.
(b) An individual who is determined to be eligible for
services under the <chronically ill and disabled children's>
services program for children with special health care needs shall
be given approved services through that program. An individual who
does not meet that eligibility criteria shall be referred to the
newborn screening program for a determination of eligibility for
newborn screening program services.
SECTION ____. Section 109.066, Health and Safety Code, is
amended to read as follows:
Sec. 109.066. TEXAS DEPARTMENT OF HEALTH PROGRAMS. (a) The
department may use appropriated funds, in accordance with the
General Appropriations Act, to purchase coverage under a health
benefit plan provided through the program for children who are
eligible for coverage for the program if:
(1) the children receive health care benefits under
the services <chronically ill and disabled children's> program for
children with special health care needs or another federally funded
or state-funded program, other than the state Medicaid program,
that is administered by the department;
(2) provision of the benefits through a health benefit
plan provided through the program is a more cost-effective means of
providing some or all of the benefits described by Subdivision (1);
and
(3) no benefit or service provided to the children is
eliminated or adversely affected as a result of the provision of
the benefits through the program.
(b) Services provided to children under a federally funded
or state-funded program administered by the department, including
the <chronically ill and disabled children's> program for children
with special health care needs, may not be reduced or eliminated
because some or all of the services are provided through the
program or otherwise provided because of the establishment of the
corporation or the program.
SECTION ____. Section 14(b)(2), Article 21.58A, Insurance
Code, is amended to read as follows:
(2) Except as provided by Subsection (g) of this
section, this article shall not apply to the Texas Medicaid
Program, the <chronically ill and disabled children's> services
program for children with special health care needs created
pursuant to Chapter 35, Health and Safety Code, any program
administered under Title 2, Human Resources Code, any program of
the Texas Department of Mental Health and Mental Retardation, or
any program of the Texas Department of Criminal Justice.
SECTION ____. Section 35.002, Health and Safety Code, is
repealed.
SECTION ____. (a) The change in law made by this article to
Chapter 35, Health and Safety Code, applies only to delivery of
services under that chapter on or after July 1, 2001.
(b) The Texas Department of Health shall implement the
health benefits plan required by Section 35.0031, Health and Safety
Code, as added by this article, not later than July 1, 2001.
(c) The Texas Board of Health shall adopt all rules
necessary to implement the changes in law made by this article not
later than July 1, 2001.