By Maxey H.B. No. 2558
76R8795 AJA-D
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) "AIDS" has the meaning assigned by Section 81.101.
1-14 (2) "Case management services" includes:
1-15 (A) coordinating medical services, marshaling
1-16 available assistance, serving as a liaison between the child and
1-17 the child's family and caregivers, institutional services,
1-18 insurance services, and other services needed to improve the
1-19 well-being of the child and the child's family; and
1-20 (B) counseling for the child and the child's
1-21 family about measures to prevent the transmission of AIDS or HIV
1-22 and the availability in the geographic area of any appropriate
1-23 health care services, such as mental health care, psychological
1-24 health care, and social and support services.
2-1 (3) "Child with special health care needs" means a
2-2 person who is younger than 21 years of age and who has a physical
2-3 or mental condition that:
2-4 (A) causes substantial and ongoing functional
2-5 limitations in mobility, self-care, communication or social
2-6 interaction, learning, self-direction, vision, hearing, or capacity
2-7 for independent living or economic self-sufficiency; and
2-8 (B) may require, to achieve optimal care for the
2-9 individual, access to a complex array of public or private
2-10 services:
2-11 (i) the access to or coordination of which
2-12 may exceed the immediate capabilities of the family or caregivers;
2-13 (ii) the need for which is expected to be
2-14 for the individual's lifetime or an extended duration; and
2-15 (iii) that require individualized planning
2-16 and coordination.
2-17 (4) "Dentist" means a person licensed by the State
2-18 Board of Dental Examiners to practice dentistry in this state.
2-19 (5) "Facility" includes a hospital, an ambulatory
2-20 surgical center, and an outpatient clinic.
2-21 (6) "Family support services" means support,
2-22 resources, or other assistance provided to the family of a child
2-23 with special health care needs, including services described by
2-24 Part I of the Individuals with Disabilities Education Act (20
2-25 U.S.C. Section 1400 et seq.), as amended, and permanancy planning,
2-26 as that term is defined by Section 531.151, Government Code.
2-27 (7) "HIV" has the meaning assigned by Section 81.101.
3-1 (8) "Other benefit" means a benefit, other than a
3-2 benefit provided under this chapter, to which a person is entitled
3-3 for payment of the costs of services provided under the program,
3-4 including benefits available from:
3-5 (A) an insurance policy, group health plan,
3-6 health maintenance organization, or prepaid medical or dental care
3-7 plan;
3-8 (B) Title XVIII, Title XIX, or Title XXI of the
3-9 Social Security Act (42 U.S.C. Sections 1395 et seq., 1396 et seq.,
3-10 and 1397aa et seq.), as amended;
3-11 (C) the Department of Veterans Affairs;
3-12 (D) the Civilian Health and Medical Program of
3-13 the Uniformed Services;
3-14 (E) workers' compensation or any other
3-15 compulsory employers' insurance program;
3-16 (F) a public program created by federal or state
3-17 law or the ordinances or rules of a municipality or other political
3-18 subdivision of the state, excluding benefits created by the
3-19 establishment of a municipal or county hospital, a joint
3-20 municipal-county hospital, a county hospital authority, a hospital
3-21 district, or the facilities of a publicly supported medical school;
3-22 or
3-23 (G) a cause of action for the cost of care,
3-24 including medical care, dental care, facility care, and medical
3-25 supplies, required for a person applying for or receiving services
3-26 from the department, or a settlement or judgment based on the cause
3-27 of action, if the expenses are related to the need for services
4-1 provided under this chapter.
4-2 (9) "Physician" means a person licensed by the Texas
4-3 State Board of Medical Examiners to practice medicine in this
4-4 state.
4-5 (10) "Program" means the services program for children
4-6 with special health care needs.
4-7 (11) "Provider" means a person who delivers services
4-8 purchased by the department for the purposes of this chapter.
4-9 (12) "Rehabilitation services" means the process of
4-10 the physical restoration or improvement of a body function
4-11 destroyed or impaired by congenital defect, disease, or injury, and
4-12 includes:
4-13 (A) facility care, medical and dental care, and
4-14 occupational and physical therapy;
4-15 (B) the provision of braces, artificial
4-16 appliances, durable medical equipment, and other medical supplies;
4-17 and
4-18 (C) other types of care specified by the board
4-19 in the program rules.
4-20 (13) "Services" means the care, activities, and
4-21 supplies provided under this chapter or program rules, including
4-22 medical care, dental care, facility care, medical supplies,
4-23 occupational and physical therapy, and other care specified by
4-24 program rules.
4-25 (14) "Specialty center" means facility and staff that
4-26 meet minimum standards established under the program and are
4-27 designated by the board for program use in the comprehensive
5-1 diagnostic and treatment services for a specific medical condition.
5-2 (15) "Support" means to contribute money or services
5-3 necessary for a person's maintenance, including food, clothing,
5-4 shelter, transportation, and health care.
5-5 SECTION 3. Section 35.003, Health and Safety Code, is
5-6 amended to read as follows:
5-7 Sec. 35.003. [CHRONICALLY ILL AND DISABLED CHILDREN'S]
5-8 SERVICES PROGRAM FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS. (a)
5-9 The program is in the department to provide services to eligible
5-10 [chronically ill and disabled] children with special health care
5-11 needs. The program shall provide:
5-12 (1) early identification of [chronically ill and
5-13 disabled] children with special health care needs;
5-14 (2) diagnosis and evaluation of [chronically ill and
5-15 disabled] children with special health care needs;
5-16 (3) rehabilitation services to [chronically ill and
5-17 disabled] children with special health care needs;
5-18 (4) development and improvement of standards and
5-19 services for [chronically ill and disabled] children with special
5-20 health care needs; [and]
5-21 (5) case management services;
5-22 (6) other family support services; and
5-23 (7) access to health benefits plan coverage under
5-24 Section 35.0031.
5-25 (b) The board by rule shall:
5-26 (1) specify the type, amount, and duration of services
5-27 to be provided under this chapter;
6-1 [(2) specify the diseases and conditions covered by
6-2 the program;] and
6-3 (2) [(3)] permit the payment of insurance premiums for
6-4 eligible children.
6-5 (c) If budgetary limitations exist, the board by rule shall
6-6 establish a system of priorities relating to the types of services
6-7 or the classes of persons eligible for the services. A waiting
6-8 list of eligible persons may be established if necessary for the
6-9 program to remain within the budgetary limitations.
6-10 (d) The program may provide:
6-11 (1) transportation and subsistence for an eligible
6-12 [chronically ill and disabled] child with special health care needs
6-13 and the child's parent, managing conservator, guardian, or other
6-14 adult caretaker approved by the program to obtain services provided
6-15 by the program; and
6-16 (2) the following services to an eligible child with
6-17 special health care needs [chronically ill and disabled children]
6-18 who dies [die] in an approved facility outside the child's
6-19 municipality of residence while receiving program services [for a
6-20 condition covered by the program]:
6-21 (A) the transportation of the child's remains,
6-22 and the transportation of a parent or other person accompanying the
6-23 remains, from the facility to the place of burial in this state
6-24 that is designated by the parent or other person legally
6-25 responsible for interment;
6-26 (B) the expense of embalming, if required for
6-27 transportation;
7-1 (C) the cost of a coffin purchased at a minimum
7-2 price, if a coffin is required for transportation; and
7-3 (D) any other necessary expenses directly
7-4 related to the care and return of the child's remains to the place
7-5 of burial in this state.
7-6 (e) The department may:
7-7 (1) develop methods to improve the efficiency and
7-8 effectiveness of the program; and
7-9 (2) conduct pilot studies[; and]
7-10 [(3) provide services only for conditions specified by
7-11 this chapter or by the board].
7-12 (f) The program is separate from the financial or medical
7-13 assistance program established by Chapters 31 and 32, Human
7-14 Resources Code.
7-15 SECTION 4. Chapter 35, Health and Safety Code, is amended by
7-16 adding Sections 35.0031, 35.0032, 35.0033, 35.0034, and 35.0035 to
7-17 read as follows:
7-18 Sec. 35.0031. HEALTH BENEFITS PLAN COVERAGE FOR CERTAIN
7-19 ELIGIBLE CHILDREN. The department shall develop and implement a
7-20 health benefits plan to provide coverage for a child who:
7-21 (1) is eligible for services under this chapter; and
7-22 (2) is not eligible for assistance under:
7-23 (A) a program established under Title XXI of the
7-24 Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended;
7-25 or
7-26 (B) the medical assistance program under Chapter
7-27 32, Human Resources Code.
8-1 Sec. 35.0032. BENEFITS COVERAGE REQUIRED. To the extent
8-2 possible, the health benefits plan required by Section 35.0031 must
8-3 provide benefits comparable to the benefits provided under the
8-4 state child health plan established by this state to implement
8-5 Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
8-6 seq.), as amended.
8-7 Sec. 35.0033. HEALTH BENEFITS PLAN PROVIDER. (a) A health
8-8 benefits plan provider who provides coverage for benefits under
8-9 Section 35.0031 must:
8-10 (1) hold a certificate of authority or other
8-11 appropriate license issued by the Texas Department of Insurance
8-12 that authorizes the health benefits plan provider to provide the
8-13 type of coverage to be offered under Section 35.0031; and
8-14 (2) satisfy, except as provided by Subsection (b), any
8-15 other applicable requirement of the Insurance Code or another
8-16 insurance law of this state.
8-17 (b) Except as required by the department, a health benefits
8-18 plan provider under this chapter is not subject to a law that
8-19 requires coverage or the offer of coverage of a health care service
8-20 or benefit.
8-21 Sec. 35.0034. COST-SHARING PAYMENTS. (a) Except as
8-22 provided by Subsection (b), the department may not require a child
8-23 who is provided health benefits plan coverage under Section 35.0031
8-24 and who meets the income eligibility requirement of the medical
8-25 assistance program under Chapter 32, Human Resources Code, to pay a
8-26 premium, deductible, coinsurance, or other cost-sharing payment as
8-27 a condition of health benefits plan coverage under this chapter.
9-1 (b) The department may require a child described by
9-2 Subsection (a) to pay a co-payment as a condition of health
9-3 benefits plan coverage under Section 35.0031 that is equal to any
9-4 co-payment required under the state child health plan established
9-5 by this state to implement Title XXI of the Social Security Act (42
9-6 U.S.C. Section 1397aa et seq.), as amended.
9-7 (c) The department may require a child who is provided
9-8 health benefits plan coverage under Section 35.0031 and who meets
9-9 the income eligibility requirement of a program established under
9-10 Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
9-11 seq.), as amended, to pay a premium, deductible, coinsurance, or
9-12 other cost-sharing payment as a condition of health benefits plan
9-13 coverage. The payment must be equal to any premium, deductible,
9-14 coinsurance, or other cost-sharing payment required under the state
9-15 child health plan established by this state to implement Title XXI
9-16 of the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
9-17 amended.
9-18 Sec. 35.0035. DISALLOWANCE OF MATCHING FUNDS FROM FEDERAL
9-19 GOVERNMENT. Expenditures made to provide health benefits plan
9-20 coverage under Section 35.0031 may not be included for the purpose
9-21 of determining the state children's health insurance expenditures,
9-22 as that term is defined by 42 U.S.C. Section 1397ee(d)(2)(B), as
9-23 amended.
9-24 SECTION 5. Section 35.004, Health and Safety Code, is
9-25 amended by adding Subsection (j) to read as follows:
9-26 (j) This section does not apply to services for which
9-27 coverage is provided under the health benefits plan established
10-1 under Section 35.0031.
10-2 SECTION 6. Section 35.005, Health and Safety Code, is
10-3 amended to read as follows:
10-4 Sec. 35.005. ELIGIBILITY FOR SERVICES. (a) The board by
10-5 rule shall:
10-6 (1) define medical, financial, and other criteria for
10-7 eligibility to receive services; and
10-8 (2) establish a system for verifying eligibility
10-9 information submitted by an applicant for or recipient of services.
10-10 (b) In defining medical and financial criteria for
10-11 eligibility under Subsection (a), the board may not:
10-12 (1) establish an exclusive list of coverable medical
10-13 conditions; or
10-14 (2) consider as a source of support to provide
10-15 services assets legally owned or available to a child's household.
10-16 (c) [(b)] A child is not eligible to receive rehabilitation
10-17 services unless:
10-18 (1) the child is a resident of this state;
10-19 (2) at least one physician or dentist certifies to the
10-20 department that the physician or dentist has examined the child and
10-21 finds the child to be a [chronically ill and disabled] child with
10-22 special health care needs whose disability meets the medical
10-23 criteria established by the board;
10-24 (3) the certifying physician or dentist has reason to
10-25 expect that services will improve the child's condition or will
10-26 extend the child's ability to function independently;
10-27 (4) the department determines that the persons who
11-1 have any legal obligation to provide services for the child are
11-2 unable to pay for the entire cost of the services; and
11-3 (5) the child meets all other eligibility criteria
11-4 established by board rules.
11-5 (d) [(c)] A child is not eligible to receive services, other
11-6 than rehabilitation services, unless the child:
11-7 (1) is a resident of this state; and
11-8 (2) meets all other eligibility criteria established
11-9 by board rules.
11-10 SECTION 7. Section 35.007(e), Health and Safety Code, is
11-11 amended to read as follows:
11-12 (e) The department may collect the cost of services provided
11-13 under this chapter directly in accordance with [from] Title XVIII,
11-14 [or] Title XIX, or Title XXI of the Social Security Act (42 U.S.C.
11-15 Sections 1395 et seq., [and] 1396 et seq., and 1397aa et seq.), as
11-16 amended, any personal insurance, a health maintenance organization,
11-17 or any other third party who has a legal obligation to pay other
11-18 benefits.
11-19 SECTION 8. Sections 35.012(a) and (b), Health and Safety
11-20 Code, are amended to read as follows:
11-21 (a) The department may take a census, make surveys, and
11-22 establish permanent records of [chronically ill and disabled]
11-23 children with special health care needs.
11-24 (b) The department shall maintain a record of orthotic and
11-25 prosthetic devices, durable medical equipment, and medical supplies
11-26 purchased by the department for [chronically ill and disabled]
11-27 children with special health care needs. Those items are not
12-1 state-owned personal property and are exempt from the personal
12-2 property inventory requirements of Subtitle D, Title 10, Government
12-3 Code.
12-4 SECTION 9. The heading of Chapter 35, Health and Safety
12-5 Code, is amended to read as follows:
12-6 CHAPTER 35. CHILDREN WITH SPECIAL HEALTH CARE NEEDS
12-7 [CHRONICALLY ILL AND DISABLED CHILDREN'S SERVICES]
12-8 SECTION 10. Section 33.031, Health and Safety Code, is
12-9 amended to read as follows:
12-10 Sec. 33.031. COORDINATION WITH CHILDREN WITH SPECIAL HEALTH
12-11 CARE NEEDS [CHRONICALLY ILL AND DISABLED CHILDREN'S] SERVICES. (a)
12-12 All newborn children and other individuals under 21 years of age
12-13 who have been screened, have been found to be presumptively
12-14 positive through the newborn screening program, and may be
12-15 financially eligible may be referred to the department's
12-16 [chronically ill and disabled children's] services program for
12-17 children with special health care needs.
12-18 (b) An individual who is determined to be eligible for
12-19 services under the [chronically ill and disabled children's]
12-20 services program for children with special health care needs shall
12-21 be given approved services through that program. An individual who
12-22 does not meet that eligibility criteria shall be referred to the
12-23 newborn screening program for a determination of eligibility for
12-24 newborn screening program services.
12-25 SECTION 11. Section 109.066, Health and Safety Code, is
12-26 amended to read as follows:
12-27 Sec. 109.066. TEXAS DEPARTMENT OF HEALTH PROGRAMS. (a) The
13-1 department may use appropriated funds, in accordance with the
13-2 General Appropriations Act, to purchase coverage under a health
13-3 benefit plan provided through the program for children who are
13-4 eligible for coverage for the program if:
13-5 (1) the children receive health care benefits under
13-6 the [chronically ill and disabled children's] services program for
13-7 children with special health care needs or another federally funded
13-8 or state-funded program, other than the state Medicaid program,
13-9 that is administered by the department;
13-10 (2) provision of the benefits through a health benefit
13-11 plan provided through the program is a more cost-effective means of
13-12 providing some or all of the benefits described by Subdivision (1);
13-13 and
13-14 (3) no benefit or service provided to the children is
13-15 eliminated or adversely affected as a result of the provision of
13-16 the benefits through the program.
13-17 (b) Services provided to children under a federally funded
13-18 or state-funded program administered by the department, including
13-19 the [chronically ill and disabled children's] program for children
13-20 with special health care needs, may not be reduced or eliminated
13-21 because some or all of the services are provided through the
13-22 program or otherwise provided because of the establishment of the
13-23 corporation or the program.
13-24 SECTION 12. Section 14(b)(2), Article 21.58A, Insurance
13-25 Code, is amended to read as follows:
13-26 (2) Except as provided by Subsection (g) of this
13-27 section, this article shall not apply to the Texas Medicaid
14-1 Program, the [chronically ill and disabled children's] services
14-2 program for children with special health care needs created
14-3 pursuant to Chapter 35, Health and Safety Code, any program
14-4 administered under Title 2, Human Resources Code, any program of
14-5 the Texas Department of Mental Health and Mental Retardation, or
14-6 any program of the Texas Department of Criminal Justice.
14-7 SECTION 13. Section 35.002, Health and Safety Code, is
14-8 repealed.
14-9 SECTION 14. (a) This Act takes effect September 1, 1999,
14-10 and applies only to delivery of services under Chapter 35, Health
14-11 and Safety Code, as amended by this Act, on or after January 1,
14-12 2000.
14-13 (b) The Texas Department of Health shall implement the
14-14 health benefits plan required by Section 35.0031, Health and Safety
14-15 Code, as added by this Act, not later than January 1, 2000.
14-16 (c) The Texas Board of Health shall adopt all rules
14-17 necessary to implement the changes in law made by this Act not
14-18 later than January 1, 2000.
14-19 SECTION 15. The importance of this legislation and the
14-20 crowded condition of the calendars in both houses create an
14-21 emergency and an imperative public necessity that the
14-22 constitutional rule requiring bills to be read on three several
14-23 days in each house be suspended, and this rule is hereby suspended.