76R11092 AJA-D
By Maxey H.B. No. 2558
Substitute the following for H.B. No. 2558:
By Maxey C.S.H.B. No. 2558
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a program providing services to certain children with
1-3 special health care needs.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 35.001, Health and Safety Code, is
1-6 amended to read as follows:
1-7 Sec. 35.001. SHORT TITLE. This chapter may be cited as the
1-8 Children with Special Health Care Needs [Chronically Ill and
1-9 Disabled Children's] Services Act.
1-10 SECTION 2. Chapter 35, Health and Safety Code, is amended by
1-11 adding Section 35.0021 to read as follows:
1-12 Sec. 35.0021. DEFINITIONS. In this chapter:
1-13 (1) "Case management services" includes:
1-14 (A) coordinating medical services, marshaling
1-15 available assistance, serving as a liaison between the child and
1-16 the child's family and caregivers, institutional services,
1-17 insurance services, and other services needed to improve the
1-18 well-being of the child and the child's family; and
1-19 (B) counseling for the child and the child's
1-20 family about measures to prevent the transmission of AIDS or HIV
1-21 and the availability in the geographic area of any appropriate
1-22 health care services, such as mental health care, psychological
1-23 health care, and social and support services.
1-24 (2) "Child with special health care needs" means a
2-1 person who:
2-2 (A) is younger than 21 years of age and who has
2-3 a physical or mental condition that:
2-4 (i) causes substantial and ongoing
2-5 functional limitations in mobility, self-care, communication or
2-6 social interaction, learning, self-direction, vision, hearing, or
2-7 capacity for independent living or economic self-sufficiency; and
2-8 (ii) may require, to achieve optimal care
2-9 for the individual, access to a complex array of public or private
2-10 services:
2-11 (a) the access to or
2-12 coordination of which may exceed the immediate capabilities of the
2-13 family or caregivers;
2-14 (b) the need for which is
2-15 expected to be for the individual's lifetime or an extended
2-16 duration; and
2-17 (c) that require
2-18 individualized planning and coordination; or
2-19 (B) has cystic fibrosis.
2-20 (3) "Dentist" means a person licensed by the State
2-21 Board of Dental Examiners to practice dentistry in this state.
2-22 (4) "Facility" includes a hospital, an ambulatory
2-23 surgical center, and an outpatient clinic.
2-24 (5) "Family support services" means support,
2-25 resources, or other assistance provided to the family of a child
2-26 with special health care needs, including services described by
2-27 Part I of the Individuals with Disabilities Education Act (20
3-1 U.S.C. Section 1400 et seq.), as amended, and permanancy planning,
3-2 as that term is defined by Section 531.151, Government Code.
3-3 (6) "Other benefit" means a benefit, other than a
3-4 benefit provided under this chapter, to which a person is entitled
3-5 for payment of the costs of services provided under the program,
3-6 including benefits available from:
3-7 (A) an insurance policy, group health plan,
3-8 health maintenance organization, or prepaid medical or dental care
3-9 plan;
3-10 (B) Title XVIII, Title XIX, or Title XXI of the
3-11 Social Security Act (42 U.S.C. Sections 1395 et seq., 1396 et seq.,
3-12 and 1397aa et seq.), as amended;
3-13 (C) the Department of Veterans Affairs;
3-14 (D) the Civilian Health and Medical Program of
3-15 the Uniformed Services;
3-16 (E) workers' compensation or any other
3-17 compulsory employers' insurance program;
3-18 (F) a public program created by federal or state
3-19 law or the ordinances or rules of a municipality or other political
3-20 subdivision of the state, excluding benefits created by the
3-21 establishment of a municipal or county hospital, a joint
3-22 municipal-county hospital, a county hospital authority, a hospital
3-23 district, or the facilities of a publicly supported medical school;
3-24 or
3-25 (G) a cause of action for the cost of care,
3-26 including medical care, dental care, facility care, and medical
3-27 supplies, required for a person applying for or receiving services
4-1 from the department, or a settlement or judgment based on the cause
4-2 of action, if the expenses are related to the need for services
4-3 provided under this chapter.
4-4 (7) "Physician" means a person licensed by the Texas
4-5 State Board of Medical Examiners to practice medicine in this
4-6 state.
4-7 (8) "Program" means the services program for children
4-8 with special health care needs.
4-9 (9) "Provider" means a person who delivers services
4-10 purchased by the department for the purposes of this chapter.
4-11 (10) "Rehabilitation services" means the process of
4-12 the physical restoration or improvement of a body function
4-13 destroyed or impaired by congenital defect, disease, or injury, and
4-14 includes:
4-15 (A) facility care, medical and dental care, and
4-16 occupational and physical therapy;
4-17 (B) the provision of braces, artificial
4-18 appliances, durable medical equipment, and other medical supplies;
4-19 and
4-20 (C) other types of care specified by the board
4-21 in the program rules.
4-22 (11) "Services" means the care, activities, and
4-23 supplies provided under this chapter or program rules, including
4-24 medical care, dental care, facility care, medical supplies,
4-25 occupational and physical therapy, and other care specified by
4-26 program rules.
4-27 (12) "Specialty center" means facility and staff that
5-1 meet minimum standards established under the program and are
5-2 designated by the board for program use in the comprehensive
5-3 diagnostic and treatment services for a specific medical condition.
5-4 (13) "Support" means to contribute money or services
5-5 necessary for a person's maintenance, including food, clothing,
5-6 shelter, transportation, and health care.
5-7 SECTION 3. Section 35.003, Health and Safety Code, is
5-8 amended to read as follows:
5-9 Sec. 35.003. [CHRONICALLY ILL AND DISABLED CHILDREN'S]
5-10 SERVICES PROGRAM FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS. (a)
5-11 The program is in the department to provide services to eligible
5-12 [chronically ill and disabled] children with special health care
5-13 needs. The program shall provide:
5-14 (1) early identification of [chronically ill and
5-15 disabled] children with special health care needs;
5-16 (2) diagnosis and evaluation of [chronically ill and
5-17 disabled] children with special health care needs;
5-18 (3) rehabilitation services to [chronically ill and
5-19 disabled] children with special health care needs;
5-20 (4) development and improvement of standards and
5-21 services for [chronically ill and disabled] children with special
5-22 health care needs; [and]
5-23 (5) case management services;
5-24 (6) other family support services; and
5-25 (7) access to health benefits plan coverage under
5-26 Section 35.0031.
5-27 (b) The board by rule shall:
6-1 (1) specify the type, amount, and duration of services
6-2 to be provided under this chapter;
6-3 [(2) specify the diseases and conditions covered by
6-4 the program;] and
6-5 (2) [(3)] permit the payment of insurance premiums for
6-6 eligible children.
6-7 (c) If budgetary limitations exist, the board by rule shall
6-8 establish a system of priorities relating to the types of services
6-9 or the classes of persons eligible for the services. A waiting
6-10 list of eligible persons may be established if necessary for the
6-11 program to remain within the budgetary limitations.
6-12 (d) The program may provide:
6-13 (1) transportation and subsistence for an eligible
6-14 [chronically ill and disabled] child with special health care needs
6-15 and the child's parent, managing conservator, guardian, or other
6-16 adult caretaker approved by the program to obtain services provided
6-17 by the program; and
6-18 (2) the following services to an eligible child with
6-19 special health care needs [chronically ill and disabled children]
6-20 who dies [die] in an approved facility outside the child's
6-21 municipality of residence while receiving program services [for a
6-22 condition covered by the program]:
6-23 (A) the transportation of the child's remains,
6-24 and the transportation of a parent or other person accompanying the
6-25 remains, from the facility to the place of burial in this state
6-26 that is designated by the parent or other person legally
6-27 responsible for interment;
7-1 (B) the expense of embalming, if required for
7-2 transportation;
7-3 (C) the cost of a coffin purchased at a minimum
7-4 price, if a coffin is required for transportation; and
7-5 (D) any other necessary expenses directly
7-6 related to the care and return of the child's remains to the place
7-7 of burial in this state.
7-8 (e) The department may:
7-9 (1) develop methods to improve the efficiency and
7-10 effectiveness of the program; and
7-11 (2) conduct pilot studies[; and]
7-12 [(3) provide services only for conditions specified by
7-13 this chapter or by the board].
7-14 (f) The program is separate from the financial or medical
7-15 assistance program established by Chapters 31 and 32, Human
7-16 Resources Code.
7-17 SECTION 4. Chapter 35, Health and Safety Code, is amended by
7-18 adding Sections 35.0031, 35.0032, 35.0033, 35.0034, and 35.0035 to
7-19 read as follows:
7-20 Sec. 35.0031. HEALTH BENEFITS PLAN COVERAGE FOR CERTAIN
7-21 ELIGIBLE CHILDREN. The department shall develop and implement a
7-22 health benefits plan to provide coverage for a child who:
7-23 (1) is eligible for services under this chapter; and
7-24 (2) is not eligible for assistance under:
7-25 (A) a program established under Title XXI of the
7-26 Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended;
7-27 or
8-1 (B) the medical assistance program under Chapter
8-2 32, Human Resources Code.
8-3 Sec. 35.0032. BENEFITS COVERAGE REQUIRED. To the extent
8-4 possible, the health benefits plan required by Section 35.0031 must
8-5 provide benefits comparable to the benefits provided under the
8-6 state child health plan established by this state to implement
8-7 Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
8-8 seq.), as amended.
8-9 Sec. 35.0033. HEALTH BENEFITS PLAN PROVIDER. (a) A health
8-10 benefits plan provider who provides coverage for benefits under
8-11 Section 35.0031 must:
8-12 (1) hold a certificate of authority or other
8-13 appropriate license issued by the Texas Department of Insurance
8-14 that authorizes the health benefits plan provider to provide the
8-15 type of coverage to be offered under Section 35.0031; and
8-16 (2) satisfy, except as provided by Subsection (b), any
8-17 other applicable requirement of the Insurance Code or another
8-18 insurance law of this state.
8-19 (b) Except as required by the department, a health benefits
8-20 plan provider under this chapter is not subject to a law that
8-21 requires coverage or the offer of coverage of a health care service
8-22 or benefit.
8-23 Sec. 35.0034. COST-SHARING PAYMENTS. (a) Except as
8-24 provided by Subsection (b), the department may not require a child
8-25 who is provided health benefits plan coverage under Section 35.0031
8-26 and who meets the income eligibility requirement of the medical
8-27 assistance program under Chapter 32, Human Resources Code, to pay a
9-1 premium, deductible, coinsurance, or other cost-sharing payment as
9-2 a condition of health benefits plan coverage under this chapter.
9-3 (b) The department may require a child described by
9-4 Subsection (a) to pay a co-payment as a condition of health
9-5 benefits plan coverage under Section 35.0031 that is equal to any
9-6 co-payment required under the state child health plan established
9-7 by this state to implement Title XXI of the Social Security Act (42
9-8 U.S.C. Section 1397aa et seq.), as amended.
9-9 (c) The department may require a child who is provided
9-10 health benefits plan coverage under Section 35.0031 and who meets
9-11 the income eligibility requirement of a program established under
9-12 Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
9-13 seq.), as amended, to pay a premium, deductible, coinsurance, or
9-14 other cost-sharing payment as a condition of health benefits plan
9-15 coverage. The payment must be equal to any premium, deductible,
9-16 coinsurance, or other cost-sharing payment required under the state
9-17 child health plan established by this state to implement Title XXI
9-18 of the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
9-19 amended.
9-20 Sec. 35.0035. DISALLOWANCE OF MATCHING FUNDS FROM FEDERAL
9-21 GOVERNMENT. Expenditures made to provide health benefits plan
9-22 coverage under Section 35.0031 may not be included for the purpose
9-23 of determining the state children's health insurance expenditures,
9-24 as that term is defined by 42 U.S.C. Section 1397ee(d)(2)(B), as
9-25 amended.
9-26 SECTION 5. Section 35.004, Health and Safety Code, is
9-27 amended by adding Subsection (j) to read as follows:
10-1 (j) This section does not apply to services for which
10-2 coverage is provided under the health benefits plan established
10-3 under Section 35.0031.
10-4 SECTION 6. Section 35.005, Health and Safety Code, is
10-5 amended to read as follows:
10-6 Sec. 35.005. ELIGIBILITY FOR SERVICES. (a) The board by
10-7 rule shall:
10-8 (1) define medical, financial, and other criteria for
10-9 eligibility to receive services; and
10-10 (2) establish a system for verifying eligibility
10-11 information submitted by an applicant for or recipient of services.
10-12 (b) In defining medical and financial criteria for
10-13 eligibility under Subsection (a), the board may not:
10-14 (1) establish an exclusive list of coverable medical
10-15 conditions; or
10-16 (2) consider as a source of support to provide
10-17 services assets legally owned or available to a child's household.
10-18 (c) [(b)] A child is not eligible to receive rehabilitation
10-19 services unless:
10-20 (1) the child is a resident of this state;
10-21 (2) at least one physician or dentist certifies to the
10-22 department that the physician or dentist has examined the child and
10-23 finds the child to be a [chronically ill and disabled] child with
10-24 special health care needs whose disability meets the medical
10-25 criteria established by the board;
10-26 (3) the certifying physician or dentist has reason to
10-27 expect that services will improve the child's condition or will
11-1 extend the child's ability to function independently;
11-2 (4) the department determines that the persons who
11-3 have any legal obligation to provide services for the child are
11-4 unable to pay for the entire cost of the services; and
11-5 (5) the child meets all other eligibility criteria
11-6 established by board rules.
11-7 (d) [(c)] A child is not eligible to receive services, other
11-8 than rehabilitation services, unless the child:
11-9 (1) is a resident of this state; and
11-10 (2) meets all other eligibility criteria established
11-11 by board rules.
11-12 SECTION 7. Section 35.007(e), Health and Safety Code, is
11-13 amended to read as follows:
11-14 (e) The department may collect the cost of services provided
11-15 under this chapter directly in accordance with [from] Title XVIII,
11-16 [or] Title XIX, or Title XXI of the Social Security Act (42 U.S.C.
11-17 Sections 1395 et seq., [and] 1396 et seq., and 1397aa et seq.), as
11-18 amended, any personal insurance, a health maintenance organization,
11-19 or any other third party who has a legal obligation to pay other
11-20 benefits.
11-21 SECTION 8. Sections 35.012(a) and (b), Health and Safety
11-22 Code, are amended to read as follows:
11-23 (a) The department may take a census, make surveys, and
11-24 establish permanent records of [chronically ill and disabled]
11-25 children with special health care needs.
11-26 (b) The department shall maintain a record of orthotic and
11-27 prosthetic devices, durable medical equipment, and medical supplies
12-1 purchased by the department for [chronically ill and disabled]
12-2 children with special health care needs. Those items are not
12-3 state-owned personal property and are exempt from the personal
12-4 property inventory requirements of Subtitle D, Title 10, Government
12-5 Code.
12-6 SECTION 9. The heading of Chapter 35, Health and Safety
12-7 Code, is amended to read as follows:
12-8 CHAPTER 35. CHILDREN WITH SPECIAL HEALTH CARE NEEDS
12-9 [CHRONICALLY ILL AND DISABLED CHILDREN'S SERVICES]
12-10 SECTION 10. Section 33.031, Health and Safety Code, is
12-11 amended to read as follows:
12-12 Sec. 33.031. COORDINATION WITH CHILDREN WITH SPECIAL HEALTH
12-13 CARE NEEDS [CHRONICALLY ILL AND DISABLED CHILDREN'S] SERVICES. (a)
12-14 All newborn children and other individuals under 21 years of age
12-15 who have been screened, have been found to be presumptively
12-16 positive through the newborn screening program, and may be
12-17 financially eligible may be referred to the department's
12-18 [chronically ill and disabled children's] services program for
12-19 children with special health care needs.
12-20 (b) An individual who is determined to be eligible for
12-21 services under the [chronically ill and disabled children's]
12-22 services program for children with special health care needs shall
12-23 be given approved services through that program. An individual who
12-24 does not meet that eligibility criteria shall be referred to the
12-25 newborn screening program for a determination of eligibility for
12-26 newborn screening program services.
12-27 SECTION 11. Section 109.066, Health and Safety Code, is
13-1 amended to read as follows:
13-2 Sec. 109.066. TEXAS DEPARTMENT OF HEALTH PROGRAMS. (a) The
13-3 department may use appropriated funds, in accordance with the
13-4 General Appropriations Act, to purchase coverage under a health
13-5 benefit plan provided through the program for children who are
13-6 eligible for coverage for the program if:
13-7 (1) the children receive health care benefits under
13-8 the [chronically ill and disabled children's] services program for
13-9 children with special health care needs or another federally funded
13-10 or state-funded program, other than the state Medicaid program,
13-11 that is administered by the department;
13-12 (2) provision of the benefits through a health benefit
13-13 plan provided through the program is a more cost-effective means of
13-14 providing some or all of the benefits described by Subdivision (1);
13-15 and
13-16 (3) no benefit or service provided to the children is
13-17 eliminated or adversely affected as a result of the provision of
13-18 the benefits through the program.
13-19 (b) Services provided to children under a federally funded
13-20 or state-funded program administered by the department, including
13-21 the [chronically ill and disabled children's] program for children
13-22 with special health care needs, may not be reduced or eliminated
13-23 because some or all of the services are provided through the
13-24 program or otherwise provided because of the establishment of the
13-25 corporation or the program.
13-26 SECTION 12. Section 14(b)(2), Article 21.58A, Insurance
13-27 Code, is amended to read as follows:
14-1 (2) Except as provided by Subsection (g) of this
14-2 section, this article shall not apply to the Texas Medicaid
14-3 Program, the [chronically ill and disabled children's] services
14-4 program for children with special health care needs created
14-5 pursuant to Chapter 35, Health and Safety Code, any program
14-6 administered under Title 2, Human Resources Code, any program of
14-7 the Texas Department of Mental Health and Mental Retardation, or
14-8 any program of the Texas Department of Criminal Justice.
14-9 SECTION 13. Section 35.002, Health and Safety Code, is
14-10 repealed.
14-11 SECTION 14. (a) This Act takes effect January 1, 2001, and
14-12 applies only to delivery of services under Chapter 35, Health and
14-13 Safety Code, as amended by this Act, on or after July 1, 2001.
14-14 (b) The Texas Department of Health shall implement the
14-15 health benefits plan required by Section 35.0031, Health and Safety
14-16 Code, as added by this Act, not later than July 1, 2001.
14-17 (c) The Texas Board of Health shall adopt all rules
14-18 necessary to implement the changes in law made by this Act not
14-19 later than July 1, 2001.
14-20 SECTION 15. The importance of this legislation and the
14-21 crowded condition of the calendars in both houses create an
14-22 emergency and an imperative public necessity that the
14-23 constitutional rule requiring bills to be read on three several
14-24 days in each house be suspended, and this rule is hereby suspended.