SRC-ARR S.B. 445 76(R)   .
BILL ANALYSIS


Senate Research Center   S.B. 445
76R5883 DLF-DBy: Moncrief
Health Services
3/3/1999
As Filed


DIGEST 

Currently, Texas law does not provide for a child health plan for certain
low-income children. The lack of health insurance contributes to poor
health and reduces the quality of life for children. Uninsured children are
less likely to receive health care when they are sick than children who
have some kind of health insurance, and are less likely to receive medical
care from a physician even when they need it.  S.B. 445 creates the Texas
Children's Health Insurance Program (CHIP) a  heath plan for certain
low-income children. 

PURPOSE

As proposed, S.B. 445 creates a child health plan for certain low-income
children. 

RULEMAKING AUTHORITY

Rulemaking authority is granted to the Health and Human Services Commission
in SECTION 1 (Sections 62.051(c), 62.052(b), 62.053(c), and 62.102,
Chapters 62B and  C, Health and Safety Code) to the Texas Department of
Health in SECTION 1 (Sections 62.051(c) and 62.052(b), Health and Safety
Code), to the Texas Department of Human Services in SECTION 1 (Section
62.051(c), Health and Safety Code), to any health and human services agency
in SECTION 1 (Section 62.051(c), Health and Safety Code)  and to the Texas
Department of Insurance in Section 1 (Section 62.054(c), Chapter 62B,
Health and Safety Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Title 2C, Health and Safety Code, by adding Chapter 62,
as follows: 

CHAPTER 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN

SUBCHAPTER A. GENERAL PROVISIONS

 Sec. 62.001. DEFINITION. Defines "commission."

Sec. 62.002. NOT AN ENTITLEMENT. Provides that this chapter does not
establish an entitlement to assistance in obtaining heath benefits for a
child.  

SUBCHAPTER B. ADMINISTRATION OF CHILD HEALTH PLAN PROGRAM

Sec. 62.051. DUTIES OF COMMISSION. Requires the  Health and Human Services
Commission (commission) to develop a state-designed child health plan
program (program) to obtain heath benefits coverage for children in
low-income families.  Requires the commission to ensure that the program is
designed and administered in a manner that qualifies it for federal
funding.  Requires the commission to oversee the implementation of the
program and coordinate the activities of each agency necessary to the
implementation of the program, including certain departments.  Authorizes
the commission to adopt rules as necessary to implement this chapter.
Authorizes the commission to require certain departments or any other
health and human services agency to adopt, with the approval of the
commission, any rules that may be adopted under this subsection.
Authorizes the  commission to delegate to certain agencies the authority to
adopt any rules that may be adopted under this subsection.   

Sec. 62.052. DUTIES OF TEXAS DEPARTMENT OF HEALTH. Requires the Texas
Department of Health (TDH) to administer the child health plan (plan) under
the direction of the commission.  Sets forth requirements of  TDH.
Authorizes the commission, or TDH under the direction of and in
consultation with the commission, to adopt rules as necessary to implement
this section.   

Sec. 62.053. DUTIES OF TEXAS DEPARTMENT OF HUMAN SERVICES. Requires the
Texas Department of Human Service (TDHS) to perform certain tasks, under
the direction of the commission.  Requires TDHS, under the direction of the
commission, to perform certain tasks if the commission contracts with a
third party administrator. Requires the commission or TDHS, with
consultation with the commission, to adopt rules as necessary to implement
this section.  

Sec. 62.054. DUTIES OF TEXAS DEPARTMENT OF INSURANCE. Requires the Texas
Department of Insurance (TDI) to provide any necessary assistance with the
development of the plan, at the request of the commission. Requires TDI to
monitor the quality of the services provided by health benefit plan
providers and resolve grievances relating to the providers.  Authorizes the
commission and  TDI to adopt a memorandum of understanding that addresses
the responsibilities of each agency in developing the plan.  Requires TDI,
in consultation with the commission, to adopt rules as necessary to
implement this section. 

Sec. 62.055. THIRD PARTY ADMINISTRATOR.  Requires the commission to
contract with a third party administrator to provide enrollment services
under the program. Authorizes the third party administrator to perform
tasks under the contract that would otherwise be performed by TDHS.  

Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.  Requires the
commission to conduct a community outreach and education campaign
(campaign) to provide information relating to the availability of health
benefits for children.  Requires the commission to conduct the campaign in
coordination with the Texas Healthy Kids Corporation in a manner that
promotes the goals of both programs and minimizes duplication of effort.
Requires the campaign to include a toll-free telephone number through which
families may obtain information about health benefits coverage for
children.  Requires the commission to provide grants to community-based
organizations to implement the campaign.  Authorizes the commission to
direct TDH or TDHS to perform all or part of the outreach campaign.  

SUBCHAPTER C. ELIGIBILITY FOR COVERAGE UNDER CHILD HEALTH PLAN

Sec. 62.101. ELIGIBILITY. Provides that a child is eligible for health
benefits coverage under the plan if the child meets certain requirements.
Requires the commission to establish an income eligibility level consistent
with Title XXI of the Social Security Act and any other applicable law or
regulations, and subject to the availability of appropriated money.
Prohibits the income eligibility level from being set at a level higher
than 200 percent of  the federal poverty level based on the federal Office
of Management and Budget poverty index. 

Sec. 62.102. CONTINUOUS COVERAGE. Requires the commission, by rule, to
provide that an individual who is determined to be eligible for coverage
under the child health plan remains eligible for those benefits until a
certain time. 

Sec. 62.103. APPLICATION FORM AND PROCEDURES. Requires the commission, or
TDHS at the direction of and in consultation with the commission, to adopt
an application form and application procedures for requesting plan coverage
under this chapter.  Requires the form and procedures to coordinate with
forms and procedures under the Medicaid program and forms and procedures
used by the Texas Healthy Kids Corporation so that a person may submit a
single consolidated application to seek assistance under this chapter or
the Medicaid program or from the corporation.  Authorizes the commission to
permit application to be made by mail, over the telephone, or through the
Internet. 

Sec. 62.104. ELIGIBILITY SCREENING AND ENROLLMENT. Requires the commission,
or TDHS at the direction and in consultation with the commission, to
develop eligibility screening and enrollment procedures for children  that
comply with the requirements of 42 U.S.C. Section 1397bb, as amended, and
any other applicable law or regulations. Requires the procedures to ensure
that Medicaid-eligible children are identified and referred to the Medicaid
program.  Authorizes the Texas Integrated Enrollment Services eligibility
determination system or a compatible system to be used to screen and enroll
children under the plan.  

SUBCHAPTER D. CHILD HEALTH PLAN

Sec. 62.151. CHILD HEALTH PLAN COVERAGE. Requires the  plan to  comply with
this chapter and the coverage requirements prescribed by 42 U.S.C. Section
1397cc,  as amended, and any other applicable law or regulations. Requires
the commission to consider the health care needs of certain children.
Requires the commission to consider the health benefit plans providing
coverage to state employees under the Texas Employees Uniform Group
Insurance Benefits Act and may use a health benefit plan providing coverage
under that article as a model for the plan. Authorizes the benefits offered
under the child health plan to vary from the benefits offered state
employees. Requires the plan to allow an enrolled child with a chronic,
disabling, or life-threatening illness to select an appropriate specialist
as a primary care physician.  

Sec. 62.152. APPLICATION OF INSURANCE LAW. Provides that, to provide the
flexibility necessary to satisfy the requirements of Title XXI of the
Social Security Act, as amended, and any other applicable law or
regulations, the plan is not subject to a law that requires certain
coverage.  

Sec. 62.153. COST SHARING. Authorizes the commission to require enrollees
to share the cost of the plan, including provisions requiring enrollees
under the plan to pay certain costs. Requires the commission to require
that the premium be paid to TDH, TDHS, or the plan provider, if
cost-sharing provisions imposed under Subsection (a) include requirements
that enrollees pay  a portion of the plan premium.   

Sec. 62.154. CROWD OUT. Provides that to the extent permitted under Title
XXI of the Social Security Act, as amended, and any other applicable law or
regulations, the plan may include  waiting periods, copayments, and other
provisions to discourage certain acts.  

Sec. 62.155. CHILD HEALTH PLAN PROVIDERS. Requires the commission or TDH,
at the direction of and in consultation with the commission, to select the
plan providers under the program through a competitive bid process.
Requires a plan provider to meet certain requirements. 

SUBCHAPTER E. LEGISLATIVE OVERSIGHT

 Sec. 62.201. DEFINITION. Defines "committee."

Sec. 62.202. COMPOSITION OF COMMITTEE; PRESIDING OFFICER. Sets forth the
members of the child health plan legislative oversight committee
(committee). Provides that a member of the committee serves at the pleasure
of the appointing official. Requires the lieutenant governor and the
speaker of the house of representatives to appoint the presiding officer of
the committee on an alternating basis. Provides that the officer serves a
two-year term expiring August 31 of each odd-numbered year. 

Sec. 62.203. COMMITTEE POWERS AND DUTIES. Sets forth requirements for the
committee. Authorizes the committee to issue process, in accordance with
Section 301.024, Government Code, to compel the attendance of witnesses and
the production of books,  records, documents, and instruments required by
the committee. Requires the committee to monitor the effectiveness and
efficiency of the plan program under this chapter.  Requires the commission
and TDH to report quarterly to the committee on implementation and
administration of the plan program and the use of money appropriated for
the program. Requires the committee to request additional reports and other
information relating to the program  from the commission and certain
agencies.  Requires the committee to use the existing staff resources of
the senate and the house of representatives to assist the committee in
performing its duties.   

Sec. 62.204. REPORT. Requires the committee to report to the governor,
lieutenant governor, and speaker of the house of representatives not later
than a certain date. Sets forth the requirements of the report. 

Sec. 62.205. RIGHTS OF EMPLOYEES; RETALIATION PROHIBITED. Defines
"personnel action." Authorizes an employee of any agency described by
Section 62.203(d) to cooperate with the committee  in the performance of
its functions.  Prohibits the agency from suspending or terminating the
employment of, or taking another adverse personnel action against, an
employee of the agency solely because the employee cooperates with the
committee on good faith.   

Sec. 62.206. EXPIRATION. Provides that the committee is abolished and this
subchapter expires September 1, 2003.  

SECTION 2. Amends Section 4, Article 3.51-6, Insurance Code, to prohibit
the provisions of this article from being applicable to any policy or
contract of insurance with a state agency, department, or board providing
health services to eligible persons under Chapter 32, Human Resources Code,
or in accordance with 42 U.S.C. Sections 1396-1396g, or 42 U.S.C. Section
1397aa et seq., as amended, under a state plan.  Makes standard
recodification and conforming changes. 

SECTION 3. Requires the Health and Human Service Commission, by September
1, 1999, to develop the plan and a plan amendment. 

SECTION 4. Provides that if the Health and Human Services Commission
determines that a waiver of authorization from a federal agency is
necessary for implementation of that provision, the commission shall
request the waiver or authorization and may delay implementing that
provision until the waiver of authorization is granted. 

SECTION 5. Emergency clause.
           Effective date: upon passage.