By: Moncrief, et al. S.B. No. 445
A BILL TO BE ENTITLED
AN ACT
1-1 relating to a child health plan for certain low-income children.
1-2 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-3 SECTION 1. Subtitle C, Title 2, Health and Safety Code, is
1-4 amended by adding Chapter 62 to read as follows:
1-5 CHAPTER 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN
1-6 SUBCHAPTER A. GENERAL PROVISIONS
1-7 Sec. 62.001. DEFINITIONS. In this chapter:
1-8 (1) "Commission" means the Health and Human Services
1-9 Commission.
1-10 (2) "Commissioner" means the commissioner of health
1-11 and human services.
1-12 Sec. 62.002. NOT AN ENTITLEMENT; TERMINATION OF PROGRAM.
1-13 (a) This chapter does not establish an entitlement to assistance
1-14 in obtaining health benefits for a child.
1-15 (b) The program established under this chapter terminates at
1-16 the time that federal funding terminates under Title XXI of the
1-17 Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended,
1-18 or another law providing federal funding for a state-designed child
1-19 health plan.
1-20 (Sections 62.003 to 62.050 reserved for expansion
1-21 SUBCHAPTER B. ADMINISTRATION OF CHILD HEALTH PLAN PROGRAM
1-22 Sec. 62.051. DUTIES OF COMMISSION. (a) The commission
1-23 shall develop a state-designed child health plan program to obtain
1-24 health benefits coverage for children in low-income families. The
2-1 commission shall ensure that the child health plan program is
2-2 designed and administered in a manner that qualifies for federal
2-3 funding under Title XXI of the Social Security Act (42 U.S.C.
2-4 Section 1397aa et seq.), as amended, and any other applicable law
2-5 or regulations.
2-6 (b) The commission shall oversee the implementation of the
2-7 child health plan program and coordinate the activities of each
2-8 agency necessary to the implementation of the program, including
2-9 the Texas Department of Health, Texas Department of Human Services,
2-10 and Texas Department of Insurance.
2-11 (c) The commission may adopt rules as necessary to implement
2-12 this chapter. The commission may require the Texas Department of
2-13 Health, the Texas Department of Human Services, or any other health
2-14 and human services agency to adopt, with the approval of the
2-15 commission, any rules that may be adopted under this subsection.
2-16 With the consent of another agency, including the Texas Department
2-17 of Insurance, the commission may delegate to that agency the
2-18 authority to adopt, with the approval of the commission, any rules
2-19 that may be adopted under this subsection.
2-20 Sec. 62.052. DUTIES OF TEXAS DEPARTMENT OF HEALTH. (a) The
2-21 Texas Department of Health shall administer the child health plan
2-22 under the direction of the commission. The department shall:
2-23 (1) implement contracts with child health plan
2-24 providers under Section 62.155;
2-25 (2) monitor the providers, through reporting
2-26 requirements and other means, to ensure performance under the
3-1 contracts and quality delivery of services; and
3-2 (3) provide payment under the contracts to the
3-3 providers.
3-4 (b) The commission, or the Texas Department of Health under
3-5 the direction of and in consultation with the commission, may adopt
3-6 rules as necessary to implement this section.
3-7 Sec. 62.053. DUTIES OF TEXAS DEPARTMENT OF HUMAN SERVICES.
3-8 (a) Under the direction of the commission, the Texas Department of
3-9 Human Services shall:
3-10 (1) accept applications for coverage under the child
3-11 health plan and implement the child health plan program eligibility
3-12 screening and enrollment procedures;
3-13 (2) resolve grievances relating to eligibility
3-14 determinations; and
3-15 (3) coordinate the child health plan program with the
3-16 Medicaid program.
3-17 (b) If the commission contracts with a third party
3-18 administrator under Section 62.055, the Texas Department of Human
3-19 Services, under the direction of the commission, shall:
3-20 (1) implement the contract;
3-21 (2) monitor the third party administrator, through
3-22 reporting requirements and other means, to ensure performance under
3-23 the contract and quality delivery of services; and
3-24 (3) provide payment under the contract to the third
3-25 party administrator.
3-26 (c) The commission, or the Texas Department of Human
4-1 Services under the direction of and in consultation with the
4-2 commission, may adopt rules as necessary to implement this section.
4-3 Sec. 62.054. DUTIES OF TEXAS DEPARTMENT OF INSURANCE.
4-4 (a) At the request of the commission, the Texas Department of
4-5 Insurance shall provide any necessary assistance with the
4-6 development of the child health plan. The department shall monitor
4-7 the quality of the services provided by health benefit plan
4-8 providers and resolve grievances relating to the providers.
4-9 (b) The commission and the Texas Department of Insurance may
4-10 adopt a memorandum of understanding that addresses the
4-11 responsibilities of each agency in developing the plan.
4-12 (c) The Texas Department of Insurance, in consultation with
4-13 the commission, may adopt rules as necessary to implement this
4-14 section.
4-15 Sec. 62.055. CONTRACTS FOR IMPLEMENTATION OF CHILD HEALTH
4-16 PLAN. (a) In administering the child health plan, the commission
4-17 may contract with:
4-18 (1) a third party administrator to provide enrollment
4-19 and related services under the state child health plan; or
4-20 (2) another entity, including the Texas Healthy Kids
4-21 Corporation under Subchapter F, Chapter 109, to obtain health
4-22 benefit plan coverage for children who are eligible for coverage
4-23 under the state child health plan.
4-24 (b) A third party administrator or other entity may perform
4-25 tasks under the contract that would otherwise be performed by the
4-26 Texas Department of Health or Texas Department of Human Services
5-1 under this chapter.
5-2 (c) If the commission enters into a contract with an entity
5-3 described by Subsection (a)(2), the commission may require the
5-4 Texas Department of Health or the Texas Department of Human
5-5 Services, as the commission determines appropriate, to:
5-6 (1) implement the contract with the entity;
5-7 (2) monitor the entity, through reporting requirements
5-8 and other means, to ensure performance under the contract and
5-9 quality delivery of services; and
5-10 (3) provide payment under the contract.
5-11 Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.
5-12 (a) The commission shall conduct a community outreach and
5-13 education campaign to provide information relating to the
5-14 availability of health benefits for children under this chapter.
5-15 The commission shall conduct the campaign in coordination with the
5-16 Texas Healthy Kids Corporation in a manner that promotes the goals
5-17 of both programs and minimizes duplication of effort.
5-18 (b) The community outreach campaign must include a toll-free
5-19 telephone number through which families may obtain information
5-20 about health benefits coverage for children.
5-21 (c) The commission may provide grants to community-based
5-22 organizations to implement the community outreach campaign.
5-23 (d) The commission may direct that the Texas Department of
5-24 Health or the Texas Department of Human Services perform all or
5-25 part of the community outreach campaign.
6-1 (Sections 62.057 to 62.100 reserved for expansion
6-2 SUBCHAPTER C. ELIGIBILITY FOR COVERAGE UNDER CHILD HEALTH PLAN
6-3 Sec. 62.101. ELIGIBILITY. (a) A child is eligible for
6-4 health benefits coverage under the child health plan if the child:
6-5 (1) is younger than 19 years of age;
6-6 (2) is not eligible for medical assistance under the
6-7 Medicaid program;
6-8 (3) is not covered by a health benefits plan offering
6-9 adequate benefits, as determined by the commission;
6-10 (4) has a family income that is less than or equal to
6-11 the income eligibility level established under Subsection (b); and
6-12 (5) satisfies any other eligibility standard imposed
6-13 under the child health plan program in accordance with 42 U.S.C.
6-14 Section 1397bb, as amended, and any other applicable law or
6-15 regulations.
6-16 (b) The commission shall establish income eligibility levels
6-17 consistent with Title XXI of the Social Security Act (42 U.S.C.
6-18 Section 1397aa et seq.), as amended, and any other applicable law
6-19 or regulations, and subject to the availability of appropriated
6-20 money. At the implementation of the program, children ages birth
6-21 through 10 years of age whose net family income is at or below 200
6-22 percent of the federal poverty level shall be eligible for health
6-23 benefits coverage. Children ages 11 through 18 years of age whose
6-24 net family income is at or below 150 percent of the federal poverty
6-25 level shall also be eligible. In this subsection, "net family
6-26 income" includes offsets for such expenses as child care and
7-1 work-related expenses consistent with Medicaid standards.
7-2 (c) The commissioner shall evaluate enrollment levels and
7-3 program impact every six months during the first 12 months of
7-4 implementation and at least annually thereafter and shall submit a
7-5 finding of fact to the Legislative Budget Board and the Governor's
7-6 Office of Budget and Planning as to the adequacy of funding and the
7-7 ability of the program to sustain enrollment at higher income
7-8 eligibility levels for children ages 11 through 18 years of age.
7-9 The commissioner shall adjust the income limit to a higher level
7-10 after submittal of a finding of fact that funding for the child
7-11 health plan is sufficient to support and sustain enrollment at the
7-12 higher level.
7-13 (d) Prior to implementation of the program and on an annual
7-14 basis thereafter, the commissioner shall evaluate enrollment levels
7-15 and program impact and submit a finding of fact to the Legislative
7-16 Budget Board and the Governor's Office of Budget and Planning as to
7-17 the adequacy of funding and the ability of the program to sustain
7-18 enrollment of children ages eight through 10 whose family income is
7-19 between 150 percent and 200 percent of the federal poverty level.
7-20 The commissioner shall adjust the income limit to a lower level
7-21 after submittal of a finding of fact that funding for the child
7-22 health plan is not sufficient to sustain enrollment at the higher
7-23 level. An adjustment to an income limit made under this subsection
7-24 shall not remove health insurance coverage from a child already
7-25 insured under this chapter.
7-26 Sec. 62.102. CONTINUOUS COVERAGE. The commission by rule
8-1 may provide that an individual who is determined to be eligible for
8-2 coverage under the child health plan remains eligible for those
8-3 benefits until the earlier of:
8-4 (1) the end of a period, not to exceed 12 months,
8-5 following the date of the eligibility determination; or
8-6 (2) the individual's 19th birthday.
8-7 Sec. 62.103. APPLICATION FORM AND PROCEDURES. (a) The
8-8 commission, or the Texas Department of Human Services at the
8-9 direction of and in consultation with the commission, shall adopt
8-10 an application form and application procedures for requesting child
8-11 health plan coverage under this chapter.
8-12 (b) To the extent possible, the form and procedures must be
8-13 coordinated with forms and procedures under the Medicaid program
8-14 and forms and procedures used by the Texas Healthy Kids Corporation
8-15 so that a person may submit a single consolidated application to
8-16 seek assistance under this chapter or the Medicaid program or from
8-17 the corporation.
8-18 (c) The commission may permit application to be made by
8-19 mail, over the telephone, or through the Internet.
8-20 Sec. 62.104. ELIGIBILITY SCREENING AND ENROLLMENT. (a) The
8-21 commission, or the Texas Department of Human Services at the
8-22 direction and in consultation with the commission, shall develop
8-23 eligibility screening and enrollment procedures for children that
8-24 comply with the requirements of 42 U.S.C. Section 1397bb, as
8-25 amended, and any other applicable law or regulations. The
8-26 procedures shall ensure that Medicaid-eligible children are
9-1 identified and referred to the Medicaid program.
9-2 (b) The Texas Integrated Enrollment Services eligibility
9-3 determination system or a compatible system may be used to screen
9-4 and enroll children under the child health plan.
9-5 (Sections 62.105 to 62.150 reserved for expansion
9-6 SUBCHAPTER D. CHILD HEALTH PLAN
9-7 Sec. 62.151. CHILD HEALTH PLAN COVERAGE. (a) The child
9-8 health plan must comply with this chapter and the coverage
9-9 requirements prescribed by 42 U.S.C. Section 1397cc, as amended,
9-10 and any other applicable law or regulations.
9-11 (b) In developing the plan, the commission shall consider
9-12 the health care needs of healthy children and children with special
9-13 health care needs. The commission shall also consider the health
9-14 benefit plans providing coverage to state employees under the Texas
9-15 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
9-16 Vernon's Texas Insurance Code) and may use a health benefit plan
9-17 providing coverage under that article as a model for the child
9-18 health plan. The benefits offered under the child health plan may
9-19 vary from the benefits offered state employees.
9-20 (c) The child health plan must allow an enrolled child with
9-21 a chronic, disabling, or life-threatening illness to select an
9-22 appropriate specialist as a primary care physician.
9-23 Sec. 62.152. APPLICATION OF INSURANCE LAW. To provide the
9-24 flexibility necessary to satisfy the requirements of Title XXI of
9-25 the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
9-26 amended, and any other applicable law or regulations, the child
10-1 health plan is not subject to a law that requires:
10-2 (1) coverage or the offer of coverage of a health care
10-3 service or benefit;
10-4 (2) coverage or the offer of coverage for the
10-5 provision of services by a particular health care services
10-6 provider; or
10-7 (3) the use of a particular policy or contract form or
10-8 of particular language in a policy or contract form.
10-9 Sec. 62.153. COST SHARING. (a) To the extent permitted
10-10 under 42 U.S.C. Section 1397cc, as amended, and any other
10-11 applicable law or regulations, the commission shall require
10-12 enrollees to share the cost of the child health plan, including
10-13 provisions requiring enrollees under the child health plan to pay:
10-14 (1) a copayment for services provided under the plan;
10-15 (2) an enrollment fee; or
10-16 (3) a portion of the plan premium.
10-17 (b) Cost-sharing provisions adopted under this section shall
10-18 ensure that families with higher levels of income are required to
10-19 pay progressively higher percentages of the cost of the plan.
10-20 (c) If cost-sharing provisions imposed under Subsection (a)
10-21 include requirements that enrollees pay a portion of the plan
10-22 premium, the commission shall specify the manner in which the
10-23 premium is paid. The commission may require that the premium be
10-24 paid to the Texas Department of Health, the Texas Department of
10-25 Human Services, or the child health plan provider.
10-26 Sec. 62.154. CROWD OUT. To the extent permitted under Title
11-1 XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.),
11-2 as amended, and any other applicable law or regulations, the child
11-3 health plan may include waiting periods, copayments, and other
11-4 provisions intended to discourage:
11-5 (1) employers and other persons from electing to
11-6 discontinue offering coverage for children under employee or other
11-7 group health benefit plans; and
11-8 (2) individuals with access to adequate health benefit
11-9 plan coverage, other than coverage under the child health plan,
11-10 from electing not to obtain or to discontinue that coverage for a
11-11 child.
11-12 Sec. 62.155. CHILD HEALTH PLAN PROVIDERS. (a) The
11-13 commission, or the Texas Department of Health at the direction of
11-14 and in consultation with the commission, shall select the child
11-15 health plan providers under the program through open enrollment or
11-16 a competitive bid process. A child health plan provider:
11-17 (1) must hold a certificate of authority or other
11-18 appropriate license issued by the Texas Department of Insurance
11-19 that authorizes the provider to provide the type of child health
11-20 plan offered and must satisfy, except as provided by this chapter,
11-21 any applicable requirement of the Insurance Code or another
11-22 insurance law of this state; or
11-23 (2) in the case of an individual health care provider,
11-24 must satisfy such certification and licensure requirements as the
11-25 commission may determine, consistent with state law.
11-26 (b) In selecting a child health plan provider, the
12-1 commission may give preference to a person who provides similar
12-2 coverage under the Medicaid program or through the Texas Healthy
12-3 Kids Corporation.
12-4 (Sections 62.156 to 62.200 reserved for expansion
12-5 SUBCHAPTER E. LEGISLATIVE OVERSIGHT
12-6 Sec. 62.201. DEFINITION. In this subchapter, "committee"
12-7 means the child health plan legislative oversight committee.
12-8 Sec. 62.202. COMPOSITION OF COMMITTEE; PRESIDING OFFICER.
12-9 (a) The committee is composed of:
12-10 (1) two members of the senate and one public member
12-11 appointed by the lieutenant governor; and
12-12 (2) two members of the house of representatives and
12-13 one public member appointed by the speaker of the house of
12-14 representatives.
12-15 (b) A member of the committee serves at the pleasure of the
12-16 appointing official.
12-17 (c) The lieutenant governor and the speaker of the house of
12-18 representatives shall appoint the presiding officer of the
12-19 committee on an alternating basis. The presiding officer serves a
12-20 two-year term expiring August 31 of each odd-numbered year.
12-21 Sec. 62.203. COMMITTEE POWERS AND DUTIES. (a) The
12-22 committee shall:
12-23 (1) meet at the call of the presiding officer;
12-24 (2) receive information about rules proposed or
12-25 adopted under this chapter; and
12-26 (3) review specific recommendations for legislation
13-1 proposed by the commission relating to administration of the child
13-2 health plan program.
13-3 (b) The committee may issue process, in accordance with
13-4 Section 301.024, Government Code, to compel the attendance of
13-5 witnesses and the production of books, records, documents, and
13-6 instruments required by the committee.
13-7 (c) The committee shall monitor the effectiveness and
13-8 efficiency of the child health plan program under this chapter.
13-9 (d) The commission and the Texas Department of Health shall
13-10 report quarterly to the committee on implementation and
13-11 administration of the child health plan program and the use of
13-12 money appropriated for the program. The committee may request
13-13 additional reports and other information relating to the child
13-14 health plan program from:
13-15 (1) the commission;
13-16 (2) the Texas Department of Health, the Texas
13-17 Department of Human Services, and any other health and human
13-18 services agency; and
13-19 (3) the Texas Department of Insurance and any other
13-20 agency necessary to the implementation of the child health plan
13-21 program.
13-22 (e) The committee shall use the existing staff resources of
13-23 the senate and the house of representatives to assist the committee
13-24 in performing its duties under this subchapter.
13-25 Sec. 62.204. REPORT. (a) The committee shall report to the
13-26 governor, lieutenant governor, and speaker of the house of
14-1 representatives not later than November 15 of each even-numbered
14-2 year.
14-3 (b) The report must include:
14-4 (1) identification of significant problems in the
14-5 administration of the child health plan program, with
14-6 recommendations for action;
14-7 (2) an analysis of the effectiveness and efficiency of
14-8 administration of the child health plan program, with
14-9 recommendations for any necessary research;
14-10 (3) an analysis of the delivery of health care
14-11 services to children in low-income families in this state; and
14-12 (4) recommendations for legislative action.
14-13 Sec. 62.205. RIGHTS OF EMPLOYEES; RETALIATION PROHIBITED.
14-14 (a) In this section, "personnel action" has the meaning assigned
14-15 by Section 554.001, Government Code.
14-16 (b) An employee of any agency described by Section 62.203(d)
14-17 may cooperate with the committee in the performance of its
14-18 functions.
14-19 (c) The agency may not suspend or terminate the employment
14-20 of, or take another adverse personnel action against, an employee
14-21 of the agency solely because the employee cooperates with the
14-22 committee in good faith.
14-23 Sec. 62.206. EXPIRATION. The committee is abolished and
14-24 this subchapter expires September 1, 2003.
14-25 SECTION 2. Chapter 109, Health and Safety Code, is amended
14-26 by adding Subchapter F to read as follows:
15-1 SUBCHAPTER F. STATE CHILD HEALTH PLAN
15-2 Sec. 109.201. DEFINITIONS. In this subchapter:
15-3 (1) "Commission" means the Health and Human Services
15-4 Commission.
15-5 (2) "State child health plan" means the child health
15-6 plan program established under Chapter 62.
15-7 Sec. 109.202. CHILD HEALTH PLAN COVERAGE. (a) The
15-8 commission may use appropriated funds, in accordance with the
15-9 General Appropriations Act, to purchase coverage under a health
15-10 benefit plan provided through the corporation for children who are
15-11 eligible for coverage under the state child health plan and to
15-12 contract with the corporation for other services under this
15-13 subchapter.
15-14 (b) State child health plan coverage offered under this
15-15 subchapter must be approved by the commission. The commission
15-16 shall ensure that coverage provided under this subchapter complies
15-17 with Chapter 62.
15-18 Sec. 109.203. ELIGIBILITY. Notwithstanding any other
15-19 provision of this chapter or the eligibility criteria established
15-20 under Section 109.061, an individual who is eligible for coverage
15-21 under the state child health plan, as determined by the commission,
15-22 is eligible for coverage provided through the corporation under
15-23 this subchapter.
15-24 Sec. 109.204. COMMUNITY OUTREACH; ELIGIBILITY SCREENING.
15-25 (a) In connection with offering state child health plan coverage
15-26 under this subchapter, the corporation, under the direction of the
16-1 commission, may:
16-2 (1) conduct all or part of the community outreach and
16-3 education campaign required under Section 62.056; and
16-4 (2) perform eligibility screening and enrollment
16-5 services.
16-6 (b) The eligibility screening and enrollment procedures used
16-7 by the corporation must comply with Chapter 62.
16-8 Sec. 109.205. REPORTING AND ACCOUNTABILITY. (a) The
16-9 corporation shall report to the commission as required by the
16-10 commission or the agency designated under Section 62.055(c) with
16-11 respect to coverage and services provided under this subchapter.
16-12 (b) The commission or the agency designated under Section
16-13 62.055(c) shall establish a procedure to monitor the provision of
16-14 coverage and services under this subchapter.
16-15 SECTION 3. Section 4, Article 3.51-6, Insurance Code, is
16-16 amended to read as follows:
16-17 Sec. 4. EXEMPTIONS. The provisions of this article shall
16-18 not be applicable to:
16-19 (1) credit accident and health insurance policies
16-20 subject to Article 3.53 of the Insurance Code, as amended;
16-21 (2) any group specifically provided for or authorized
16-22 by law in existence and covered under a policy filed with the State
16-23 Board of Insurance prior to April 1, 1975;
16-24 (3) accident and health coverages that are incidental
16-25 to any form of group automobile, casualty, property, or workmen's
16-26 compensation--employers' liability policies promulgated or approved
17-1 by the State Board of Insurance;
17-2 (4) any policy or contract of insurance with a state
17-3 agency, department, or board providing health services to [all]
17-4 eligible persons under Chapter 32, Human Resources Code, or in
17-5 accordance with 42 U.S.C. Sections 1396-1396g, as amended, or 42
17-6 U.S.C. Section 1397aa et seq., as amended, [Section 6, The Medical
17-7 Assistance Act of 1967, as amended (Article 695j--1, Vernon's Texas
17-8 Civil Statutes), 343-353 (42 U.S.C.A. 1396-1396g), providing health
17-9 care and services] under a state plan.
17-10 SECTION 4. Not later than September 1, 1999, the Health and
17-11 Human Services Commission shall:
17-12 (1) develop the child health plan required under
17-13 Chapter 62, Health and Safety Code, as added by this Act; and
17-14 (2) submit for approval a plan amendment relating to
17-15 the child health plan under 42 U.S.C. Section 1397ff, as amended.
17-16 SECTION 5. If, before implementing any provision of Chapter
17-17 62, Health and Safety Code, as added by this Act, the Health and
17-18 Human Services Commission determines that a waiver or authorization
17-19 from a federal agency is necessary for implementation of that
17-20 provision, the commission shall request the waiver or authorization
17-21 and may delay implementing that provision until the waiver or
17-22 authorization is granted.
17-23 SECTION 6. The importance of this legislation and the
17-24 crowded condition of the calendars in both houses create an
17-25 emergency and an imperative public necessity that the
17-26 constitutional rule requiring bills to be read on three several
18-1 days in each house be suspended, and this rule is hereby suspended,
18-2 and that this Act take effect and be in force from and after its
18-3 passage, and it is so enacted.