76R11454 E
By Moncrief, et al. S.B. No. 445
Substitute the following for S.B. No. 445:
By Gray C.S.S.B. No. 445
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a child health plan for certain low-income children.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subtitle C, Title 2, Health and Safety Code, is
1-5 amended by adding Chapters 62 and 63 to read as follows:
1-6 CHAPTER 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN
1-7 SUBCHAPTER A. GENERAL PROVISIONS
1-8 Sec. 62.001. DEFINITIONS. In this chapter:
1-9 (1) "Commission" means the Health and Human Services
1-10 Commission.
1-11 (2) "Commissioner" means the commissioner of health
1-12 and human services.
1-13 (3) "Health plan provider" means an insurance company,
1-14 health maintenance organization, or other entity that provides
1-15 health benefits coverage under the child health plan program. The
1-16 term includes a primary care case management provider network.
1-17 (4) "Net family income" means the amount of income
1-18 established for a family after reduction for offsets for expenses
1-19 such as child care and work-related expenses, in accordance with
1-20 standards applicable under the Medicaid program.
1-21 Sec. 62.002. NOT AN ENTITLEMENT; TERMINATION OF PROGRAM.
1-22 (a) This chapter does not establish an entitlement to assistance
1-23 in obtaining health benefits for a child.
1-24 (b) The program established under this chapter terminates at
2-1 the time that federal funding terminates under Title XXI of the
2-2 Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended,
2-3 unless a successor program providing federal funding for a
2-4 state-designed child health plan program is created.
2-5 Sec. 62.003. FEDERAL LAW AND REGULATIONS. The commissioner
2-6 shall monitor federal legislation affecting Title XXI of the Social
2-7 Security Act (42 U.S.C. Section 1397aa et seq.) and changes to the
2-8 federal regulations implementing that law. If the commissioner
2-9 determines that a change to Title XXI of the Social Security Act
2-10 (42 U.S.C. Section 1397aa et seq.) or the federal regulations
2-11 implementing that law conflicts with this chapter, the commissioner
2-12 shall report the changes to the governor, lieutenant governor, and
2-13 speaker of the house of representatives, with recommendations for
2-14 legislation necessary to implement the federal law or regulations,
2-15 seek a waiver, or withdraw from participation.
2-16 (Sections 62.004 to 62.050 reserved for expansion
2-17 SUBCHAPTER B. ADMINISTRATION OF CHILD HEALTH PLAN PROGRAM
2-18 Sec. 62.051. DUTIES OF COMMISSION. (a) The commission
2-19 shall develop a state-designed child health plan program to obtain
2-20 health benefits coverage for children in low-income families. The
2-21 plan shall include an option for the parent of the child to
2-22 participate in a medical savings account insurance program as
2-23 defined in 26 U.S.C. Section 220(d)(1) and allow a parent's
2-24 employer or other benefactor to contribute to said program. The
2-25 commission shall ensure that the child health plan and medical
2-26 savings account insurance program is designed and administered in a
2-27 manner that qualifies for federal funding under Title XXI of the
3-1 Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended,
3-2 and any other applicable law or regulations.
3-3 (b) The commission is the agency responsible for making
3-4 policy for the child health plan program, including policy related
3-5 to covered benefits provided under the child health plan. The
3-6 commission may not delegate this duty to another agency or entity.
3-7 (c) The commission shall oversee the implementation of the
3-8 child health plan program and coordinate the activities of each
3-9 agency necessary to the implementation of the program, including
3-10 the Texas Department of Health, Texas Department of Human Services,
3-11 and Texas Department of Insurance.
3-12 (d) The commission shall adopt rules as necessary to
3-13 implement this chapter. The commission may require the Texas
3-14 Department of Health, the Texas Department of Human Services, or
3-15 any other health and human services agency to adopt, with the
3-16 approval of the commission, any rules that may be necessary to
3-17 implement the program. With the consent of another agency,
3-18 including the Texas Department of Insurance, the commission may
3-19 delegate to that agency the authority to adopt, with the approval
3-20 of the commission, any rules that may be necessary to implement the
3-21 program.
3-22 (e) The commission shall conduct a review of each entity
3-23 that enters into a contract to implement any part of the child
3-24 health plan program, including an entity with which the commission
3-25 contracts under Section 62.055 and each health plan provider, to
3-26 ensure that the entity is available, prepared, and able to fulfill
3-27 the entity's obligations under the contract in compliance with the
4-1 contract, this chapter, and rules adopted under this chapter.
4-2 Sec. 62.052. DUTIES OF TEXAS DEPARTMENT OF HEALTH. (a) The
4-3 commission may direct the Texas Department of Health to:
4-4 (1) implement contracts with health plan providers
4-5 under Section 62.155;
4-6 (2) monitor the health plan providers, through
4-7 reporting requirements and other means, to ensure performance under
4-8 the contracts and quality delivery of services;
4-9 (3) monitor the quality of services delivered to
4-10 enrollees through outcome measurements including:
4-11 (A) rate of hospitalization for ambulatory
4-12 sensitive conditions, including asthma, diabetes, epilepsy,
4-13 dehydration, gastroenteritis, pneumonia, and UTI/kidney infection;
4-14 (B) rate of hospitalization for injuries;
4-15 (C) percent of enrolled adolescents reporting
4-16 risky health behavior such as injuries, tobacco use, alcohol/drug
4-17 use, dietary behavior, physical activity, or other health related
4-18 behaviors; and
4-19 (D) percent of adolescents reporting attempted
4-20 suicide; and
4-21 (4) provide payment under the contracts to the health
4-22 plan providers.
4-23 (b) The commission, or the Texas Department of Health under
4-24 the direction of and in consultation with the commission, shall
4-25 adopt rules as necessary to implement this section.
4-26 Sec. 62.053. DUTIES OF TEXAS DEPARTMENT OF HUMAN SERVICES.
4-27 (a) Under the direction of the commission, the Texas Department of
5-1 Human Services may:
5-2 (1) accept applications for coverage under the child
5-3 health plan and implement the child health plan program eligibility
5-4 screening and enrollment procedures;
5-5 (2) resolve grievances relating to eligibility
5-6 determinations; and
5-7 (3) coordinate the child health plan program with the
5-8 Medicaid program.
5-9 (b) If the commission contracts with a third party
5-10 administrator under Section 62.055, the commission may direct the
5-11 Texas Department of Human Services to:
5-12 (1) implement the contract;
5-13 (2) monitor the third party administrator, through
5-14 reporting requirements and other means, to ensure performance under
5-15 the contract and quality delivery of services; and
5-16 (3) provide payment under the contract to the third
5-17 party administrator.
5-18 (c) The commission, or the Texas Department of Human
5-19 Services under the direction of and in consultation with the
5-20 commission, shall adopt rules as necessary to implement this
5-21 section.
5-22 Sec. 62.054. DUTIES OF TEXAS DEPARTMENT OF INSURANCE.
5-23 (a) At the request of the commission, the Texas Department of
5-24 Insurance shall provide any necessary assistance with the
5-25 development of the child health plan. The department shall monitor
5-26 the quality of the services provided by health plan providers and
5-27 resolve grievances relating to the health plan providers.
6-1 (b) The commission and the Texas Department of Insurance may
6-2 adopt a memorandum of understanding that addresses the
6-3 responsibilities of each agency in developing the plan.
6-4 (c) The Texas Department of Insurance, in consultation with
6-5 the commission, shall adopt rules as necessary to implement this
6-6 section.
6-7 Sec. 62.055. CONTRACTS FOR IMPLEMENTATION OF CHILD HEALTH
6-8 PLAN. (a) In administering the child health plan, the commission
6-9 may contract with:
6-10 (1) a third party administrator to provide eligibility
6-11 screening, enrollment procedures, or related services under the
6-12 state child health plan; or
6-13 (2) another entity, including the Texas Healthy Kids
6-14 Corporation under Subchapter F, Chapter 109, to obtain health
6-15 benefit plan coverage for children who are eligible for coverage
6-16 under the state child health plan.
6-17 (b) A third party administrator or other entity may perform
6-18 tasks under the contract that would otherwise be performed by the
6-19 Texas Department of Health or Texas Department of Human Services
6-20 under this chapter.
6-21 (c) If the commission elects to contract with a third party
6-22 administrator or other entity as described in Subsection (a), the
6-23 commission shall:
6-24 (1) retain all policymaking authority over the state
6-25 child health plan;
6-26 (2) procure all contracts with a third party
6-27 administrator or other entity through a competitive procurement
7-1 process in compliance with all applicable federal and state laws or
7-2 regulations; and
7-3 (3) ensure that all contracts with child health plan
7-4 providers under Section 62.155 are procured through a competitive
7-5 procurement process in compliance with all applicable federal and
7-6 state laws or regulations.
7-7 Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.
7-8 (a) The commission shall conduct a community outreach and
7-9 education campaign to provide information relating to the
7-10 availability of health benefits for children under this chapter.
7-11 The commission shall conduct the campaign in a manner that promotes
7-12 the goals of all child health programs and minimizes duplication of
7-13 effort.
7-14 (b) The community outreach campaign must include:
7-15 (1) outreach efforts that involve school-based health
7-16 clinics; and
7-17 (2) a toll-free telephone number through which
7-18 families may obtain information about health benefits coverage for
7-19 children.
7-20 (c) The commission shall contract with community-based
7-21 organizations to implement the community outreach campaign and
7-22 shall also promote and encourage voluntary efforts to implement the
7-23 community outreach campaign. The commission shall award the
7-24 contracts in a manner that encourages broad participation of
7-25 organizations, with an emphasis on organizations that target
7-26 population groups with high levels of uninsured children.
7-27 (d) The commission may direct that the Texas Department of
8-1 Health or the Texas Department of Human Services perform part of
8-2 the community outreach campaign.
8-3 (e) The commission shall be responsible for informing each
8-4 eligible child's parent as to the existence of the medical savings
8-5 account insurance program option and providing the parent with the
8-6 opportunity to choose or refuse to participate in said program.
8-7 Sec. 62.057. ADVISORY COMMITTEE. (a) Not later than the
8-8 180th day before the date on which the commission plans to begin to
8-9 provide health care services to recipients through the child health
8-10 plan program, the commission shall appoint an advisory committee to
8-11 provide recommendations on the implementation and operation of the
8-12 child health plan program.
8-13 (b) The advisory committee must be composed of
8-14 representatives of:
8-15 (1) hospitals;
8-16 (2) insurance companies and health maintenance
8-17 organizations eligible to offer the health benefits coverage under
8-18 the child health plan;
8-19 (3) primary care providers;
8-20 (4) state agencies;
8-21 (5) consumer advocates;
8-22 (6) parents of children who are enrolled in the child
8-23 health plan;
8-24 (7) rural health care providers;
8-25 (8) advocates for children with special health care
8-26 needs;
8-27 (9) specialty health care providers, including
9-1 pediatric providers; and
9-2 (10) community-based organizations that provide
9-3 community outreach under Section 62.056.
9-4 (c) The advisory committee shall meet at least quarterly and
9-5 is subject to Chapter 551, Government Code.
9-6 (d) Section 2110.008, Government Code, does not apply to
9-7 the advisory committee.
9-8 Sec. 62.058. FRAUD PREVENTION. The commission shall develop
9-9 and implement rules for the prevention and detection of fraud in
9-10 the child health plan program.
9-11 (Sections 62.059 to 62.100 reserved for expansion
9-12 SUBCHAPTER C. ELIGIBILITY FOR COVERAGE UNDER CHILD HEALTH PLAN
9-13 Sec. 62.101. ELIGIBILITY. (a) A child is eligible for
9-14 health benefits coverage under the child health plan if the child:
9-15 (1) is younger than 19 years of age;
9-16 (2) is not eligible for medical assistance under the
9-17 Medicaid program;
9-18 (3) is not covered by a health benefits plan offering
9-19 adequate benefits, as determined by the commission, except that
9-20 this subdivision shall not apply if the cost to the child's family
9-21 of the health benefits plan covering the child exceeds 10 percent
9-22 of the family's net income;
9-23 (4) has a family income that is less than or equal to
9-24 the income eligibility level established under Subsection (b); and
9-25 (5) satisfies any other eligibility standard imposed
9-26 under the child health plan program in accordance with 42 U.S.C.
9-27 Section 1397bb, as amended, and any other applicable law or
10-1 regulations.
10-2 (b) The commission shall establish income eligibility levels
10-3 consistent with Title XXI, Social Security Act (42 U.S.C. Section
10-4 1397aa et seq.), as amended, and any other applicable law or
10-5 regulations, and subject to the availability of appropriated money.
10-6 At the implementation of the program a child who is younger than 19
10-7 years of age and whose net family income is at or below 200 percent
10-8 of the federal poverty level is eligible for health benefits
10-9 coverage under the program.
10-10 Sec. 62.102. CONTINUOUS COVERAGE. The commission shall
10-11 provide that an individual who is determined to be eligible for
10-12 coverage under the child health plan remains eligible for those
10-13 benefits until the earlier of:
10-14 (1) the end of a period, not to exceed 12 months,
10-15 following the date of the eligibility determination; or
10-16 (2) the individual's 19th birthday.
10-17 Sec. 62.103. APPLICATION FORM AND PROCEDURES. (a) The
10-18 commission, or the Texas Department of Human Services at the
10-19 direction of and in consultation with the commission, shall adopt
10-20 an application form and application procedures for requesting child
10-21 health plan coverage and the medical savings account insurance
10-22 program option under this chapter.
10-23 (b) The form and procedures must be coordinated with forms
10-24 and procedures under the Medicaid program and forms and procedures
10-25 used by the Texas Healthy Kids Corporation so that a person may
10-26 submit a single consolidated application to seek assistance under
10-27 this chapter or the Medicaid program or from the corporation.
11-1 (c) To the extent possible, the application form shall be
11-2 made available in languages other than English.
11-3 (d) The commission may permit application to be made by
11-4 mail, over the telephone, or through the Internet.
11-5 Sec. 62.104. ELIGIBILITY SCREENING AND ENROLLMENT. (a) The
11-6 commission, or the Texas Department of Human Services at the
11-7 direction and in consultation with the commission, shall develop
11-8 eligibility screening and enrollment procedures for children that
11-9 comply with the requirements of 42 U.S.C. Section 1397bb, as
11-10 amended, and any other applicable law or regulations.
11-11 (b) The Texas Integrated Enrollment Services eligibility
11-12 determination system or a compatible system may be used to screen
11-13 and enroll children under the child health plan.
11-14 (c) The eligibility screening and enrollment procedures
11-15 shall ensure that children who appear to be Medicaid-eligible are
11-16 identified and that their families are assisted in applying for
11-17 Medicaid coverage.
11-18 (d) A child who applies for enrollment in the child health
11-19 plan, who is denied Medicaid coverage after completion of a
11-20 Medicaid application under Subsection (c), but who is eligible for
11-21 enrollment in the child health plan, shall be enrolled in the child
11-22 health plan without further application or qualification.
11-23 (e) The commission shall report quarterly to the Health Care
11-24 Information Council and the committees of both houses of the
11-25 legislature with jurisdiction over the child health plan:
11-26 (1) the number of children referred for Medicaid
11-27 application under this section who are enrolled in the Medicaid
12-1 program; and
12-2 (2) the number of children who are denied coverage
12-3 under the Medicaid program because they failed to complete the
12-4 application process.
12-5 (f) A determination of whether a child is eligible for child
12-6 health plan coverage under the program and the enrollment of an
12-7 eligible child with a health plan provider must be completed in a
12-8 timely manner, as determined by the commission, but not later than
12-9 the 30th day after the date a complete application is submitted on
12-10 behalf of the child.
12-11 (g) In the first year of implementation of the child health
12-12 plan, enrollment shall be open. Thereafter, the commission may
12-13 establish enrollment periods.
12-14 Sec. 62.105. COVERAGE FOR QUALIFIED ALIENS. The commission
12-15 shall provide coverage under the state Medicaid program and under
12-16 the program established under this chapter to a child who is a
12-17 qualified alien, as that term is defined by 8 U.S.C. Section
12-18 1641(b), if the federal government authorizes the state to provide
12-19 that coverage. The commission shall comply with any prerequisite
12-20 imposed under the federal law to providing that coverage.
12-21 (Sections 62.106 to 62.150 reserved for expansion
12-22 SUBCHAPTER D. CHILD HEALTH PLAN
12-23 Sec. 62.151. CHILD HEALTH PLAN COVERAGE. (a) The child
12-24 health plan must comply with this chapter and the coverage
12-25 requirements prescribed by 42 U.S.C. Section 1397cc, as amended,
12-26 and any other applicable law or regulations.
12-27 (b) In developing the covered benefits, the commission shall
13-1 consider the health care needs of healthy children and children
13-2 with special health care needs. At the time the child health plan
13-3 program is first implemented, the child health plan must provide
13-4 covered benefits in substantial compliance with the recommended
13-5 benefits package described for a state-designed child health plan
13-6 by the Texas House of Representatives Committee on Public Health
13-7 "CHIP" Interim Report to the Seventy-Sixth Texas Legislature dated
13-8 December, 1998, and the Senate Interim Committee on Children's
13-9 Health Insurance Report to the Seventy-Sixth Texas Legislature
13-10 dated December 1, 1998. The commissioner shall annually evaluate
13-11 the covered benefits provided under the child health plan and may
13-12 modify the covered benefits as appropriate, considering the
13-13 information obtained in implementing the program and budgetary
13-14 limitations.
13-15 (c) In developing the plan, the commission shall ensure that
13-16 primary and preventive health benefits do not include reproductive
13-17 services.
13-18 (d) The child health plan must allow an enrolled child with
13-19 a chronic, disabling, or life-threatening illness to select an
13-20 appropriate specialist as a primary care physician.
13-21 Sec. 62.152. APPLICATION OF INSURANCE LAW. To provide the
13-22 flexibility necessary to satisfy the requirements of Title XXI of
13-23 the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
13-24 amended, and any other applicable law or regulations, the child
13-25 health plan is not subject to a law that requires:
13-26 (1) coverage or the offer of coverage of a health care
13-27 service or benefit;
14-1 (2) coverage or the offer of coverage for the
14-2 provision of services by a particular health care services
14-3 provider, except as provided by Section 62.155(c); or
14-4 (3) the use of a particular policy or contract form or
14-5 of particular language in a policy or contract form.
14-6 Sec. 62.153. COST SHARING. (a) To the extent permitted
14-7 under 42 U.S.C. Section 1397cc, as amended, and any other
14-8 applicable law or regulations, the commission shall require
14-9 enrollees to share the cost of the child health plan, including
14-10 provisions requiring enrollees under the child health plan to pay:
14-11 (1) a copayment for services provided under the plan;
14-12 (2) an enrollment fee; or
14-13 (3) a portion of the plan premium.
14-14 (b) Cost-sharing provisions adopted under this section shall
14-15 ensure that families with higher levels of income are required to
14-16 pay progressively higher percentages of the cost of the plan.
14-17 (c) If cost-sharing provisions imposed under Subsection (a)
14-18 include requirements that enrollees pay a portion of the plan
14-19 premium, the commission shall specify the manner in which the
14-20 premium is paid. The commission may require that the premium be
14-21 paid to the Texas Department of Health, the Texas Department of
14-22 Human Services, or the health plan provider.
14-23 Sec. 62.154. CROWD OUT. (a) To the extent permitted under
14-24 Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
14-25 seq.), as amended, and any other applicable law or regulations, the
14-26 child health plan must include a waiting period and may include
14-27 copayments and other provisions intended to discourage:
15-1 (1) employers and other persons from electing to
15-2 discontinue offering coverage for children under employee or other
15-3 group health benefit plans; and
15-4 (2) individuals with access to adequate health benefit
15-5 plan coverage, other than coverage under the child health plan,
15-6 from electing not to obtain or to discontinue that coverage for a
15-7 child.
15-8 (b) A child is not subject to a waiting period adopted under
15-9 Subsection (a) if:
15-10 (1) the family lost coverage for the child as a result
15-11 of:
15-12 (A) termination of employment because of a
15-13 layoff or business closing;
15-14 (B) termination of continuation coverage under
15-15 the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L.
15-16 No. 99-272);
15-17 (C) change in marital status of a parent of the
15-18 child; or
15-19 (D) similar circumstance resulting in the
15-20 involuntary loss of coverage; or
15-21 (2) the commission has determined that other grounds
15-22 exist for a good cause exception.
15-23 (c) A child described by Subsection (b)(2) may enroll in the
15-24 child health plan program at any time, without regard to any open
15-25 enrollment period established under the enrollment procedures.
15-26 (d) The waiting period required by Subsection (a) must:
15-27 (1) extend for a period of 90 days after the date of
16-1 application for coverage under the child health plan; and
16-2 (2) apply to a child who was covered by a health
16-3 benefits plan at any time during the 90 days before the date of
16-4 application for coverage under the child health plan, other than a
16-5 child who was covered under a health benefits plan provided under
16-6 Chapter 109.
16-7 Sec. 62.155. HEALTH PLAN PROVIDERS. (a) The commission, or
16-8 the Texas Department of Health at the direction of and in
16-9 consultation with the commission, shall select the health plan
16-10 providers under the program through open enrollment or a
16-11 competitive bid process. A health plan provider must hold a
16-12 certificate of authority or other appropriate license issued by the
16-13 Texas Department of Insurance that authorizes the health plan
16-14 provider to provide the type of child health plan offered and must
16-15 satisfy, except as provided by this chapter, any applicable
16-16 requirement of the Insurance Code or another insurance law of this
16-17 state.
16-18 (b) In selecting a health plan provider to provide or
16-19 arrange for services in a region of the state under a type of child
16-20 health plan that includes managed care organizations, the
16-21 commission shall give to the extent possible preference to a
16-22 managed care organization that provides similar coverage under a
16-23 contract with the Medicaid program or with the Texas Healthy Kids
16-24 Corporation in that region.
16-25 (c) Section 533.006, Government Code, applies to a managed
16-26 care organization or other entity that:
16-27 (1) contracts with the commission or with another
17-1 agency or entity to operate a part of the child health plan under
17-2 this chapter; and
17-3 (2) uses a provider network to provide or arrange for
17-4 health care services under the child health plan.
17-5 (d) In selecting a health plan provider, the commission:
17-6 (1) may give preference to a person who provides
17-7 similar coverage under the Medicaid program or through the Texas
17-8 Healthy Kids Corporation; and
17-9 (2) shall provide for a choice of at least two health
17-10 plan providers in each metropolitan area.
17-11 (e) In a metropolitan area in which the Medicaid managed
17-12 care program established under Chapter 533, Government Code, has
17-13 been implemented, at least one of the health plan providers must be
17-14 a managed care organization that is participating in the Medicaid
17-15 managed care program.
17-16 (f) The commissioner may authorize an exception to
17-17 Subsection (b)(2) if there is only one acceptable applicant to
17-18 become a health plan provider in the metropolitan area.
17-19 Sec. 62.156. HEALTH CARE PROVIDERS. An individual health
17-20 care provider who provides health care services under the child
17-21 health plan must satisfy certification and licensure requirements,
17-22 as required by the commission, consistent with law.
17-23 CHAPTER 63. HEALTH BENEFITS PLAN FOR CERTAIN CHILDREN
17-24 Sec. 63.001. DEFINITION. In this chapter, "commission"
17-25 means the Health and Human Services Commission.
17-26 Sec. 63.002. HEALTH BENEFITS PLAN COVERAGE FOR CERTAIN
17-27 CHILDREN. The commission shall develop and implement a program to
18-1 provide health benefits plan coverage for a child who:
18-2 (1) is a qualified alien, as that term is defined by 8
18-3 U.S.C. Section 1641(b);
18-4 (2) is younger than 19 years of age;
18-5 (3) entered the United States after August 22, 1996;
18-6 (4) has resided in the United States for less than
18-7 five years; and
18-8 (5) meets the income eligibility requirement of, but
18-9 is not eligible for assistance under:
18-10 (A) the child health plan program under Chapter
18-11 62; or
18-12 (B) the medical assistance program under Chapter
18-13 32, Human Resources Code.
18-14 Sec. 63.003. BENEFITS COVERAGE REQUIRED. To the extent
18-15 possible, the program required by Section 63.002 must provide
18-16 benefits comparable to the benefits provided under the child health
18-17 plan program under Chapter 62.
18-18 Sec. 63.004. HEALTH BENEFITS PLAN PROVIDER. (a) A health
18-19 benefits plan provider under this chapter must:
18-20 (1) hold a certificate of authority or other
18-21 appropriate license issued by the Texas Department of Insurance
18-22 that authorizes the health benefits plan provider to provide the
18-23 type of coverage to be offered through the program required by
18-24 Section 63.002; and
18-25 (2) satisfy, except as provided by Subsection (b), any
18-26 other applicable requirement of the Insurance Code or another
18-27 insurance law of this state.
19-1 (b) Except as required by the commission, a health benefits
19-2 plan provider under this chapter is not subject to a law that
19-3 requires coverage or the offer of coverage of a health care service
19-4 or benefit.
19-5 Sec. 63.005. COST-SHARING PAYMENTS. (a) Except as provided
19-6 by Subsection (b), the commission may not require a child who is
19-7 provided health benefits plan coverage under Section 63.002 and who
19-8 meets the income eligibility requirement of the medical assistance
19-9 program under Chapter 32, Human Resources Code, to pay a premium,
19-10 deductible, coinsurance, or other cost-sharing payment as a
19-11 condition of health benefits plan coverage under this chapter.
19-12 (b) The commission may require a child described by
19-13 Subsection (a) to pay a co-payment as a condition of health
19-14 benefits plan coverage under this chapter that is equal to any
19-15 co-payment required under the child health plan program under
19-16 Chapter 62.
19-17 (c) The commission may require a child who is provided
19-18 health benefits plan coverage under Section 63.002 and who meets
19-19 the income eligibility requirement of the child health plan program
19-20 under Chapter 62 to pay a premium, deductible, coinsurance, or
19-21 other cost-sharing payment as a condition of health benefits plan
19-22 coverage under this chapter. The payment must be equal to any
19-23 premium, deductible, coinsurance, or other cost-sharing payment
19-24 required under the child health plan program under Chapter 62.
19-25 Sec. 63.006. DISALLOWANCE OF MATCHING FUNDS FROM FEDERAL
19-26 GOVERNMENT. Expenditures made to provide health benefits plan
19-27 coverage under this section may not be included for the purpose of
20-1 determining the state children's health insurance expenditures, as
20-2 that term is defined by 42 U.S.C. Section 1397ee(d)(2)(B), as
20-3 amended.
20-4 SECTION 2. Chapter 109, Health and Safety Code, is amended
20-5 by adding Subchapter F to read as follows:
20-6 SUBCHAPTER F. STATE CHILD HEALTH PLAN
20-7 Sec. 109.201. DEFINITIONS. In this subchapter:
20-8 (1) "Commission" means the Health and Human Services
20-9 Commission.
20-10 (2) "State child health plan" means the child health
20-11 plan program established under Chapter 62.
20-12 Sec. 109.202. CHILD HEALTH PLAN COVERAGE. (a) The
20-13 commission may use appropriated funds, in accordance with the
20-14 General Appropriations Act, to purchase coverage under a health
20-15 benefit plan provided through the corporation for children who are
20-16 eligible for coverage under the state child health plan and to
20-17 contract with the corporation for other services under this
20-18 subchapter.
20-19 (b) State child health plan coverage offered under this
20-20 subchapter must be approved by the commission. The commission
20-21 shall ensure that coverage provided under this subchapter complies
20-22 with Chapter 62.
20-23 Sec. 109.203. ELIGIBILITY. Notwithstanding any other
20-24 provision of this chapter or the eligibility criteria established
20-25 under Section 109.061, an individual who is eligible for coverage
20-26 under the state child health plan, as determined by the commission,
20-27 is eligible for coverage provided through the corporation under
21-1 this subchapter.
21-2 Sec. 109.204. COMMUNITY OUTREACH; ELIGIBILITY SCREENING.
21-3 (a) In connection with offering state child health plan coverage
21-4 under this subchapter, the corporation, under the direction of the
21-5 commission, may:
21-6 (1) conduct all or part of the community outreach and
21-7 education campaign required under Section 62.056; and
21-8 (2) perform eligibility screening and enrollment
21-9 services.
21-10 (b) The eligibility screening and enrollment procedures used
21-11 by the corporation must comply with Chapter 62.
21-12 Sec. 109.205. COMPETITIVE PROCUREMENT. (a) If the
21-13 corporation is selected to offer state child health plan coverage
21-14 under this subchapter and subsequently as required by the
21-15 commission or otherwise appropriate, the corporation shall use a
21-16 competitive procurement process, satisfactory to the commission, to
21-17 ensure that the state receives the best value with respect to:
21-18 (1) a contract with any third party administrator that
21-19 may provide services with respect to the state child health plan;
21-20 and
21-21 (2) any eligible coverage providers providing health
21-22 benefits through the state child health plan.
21-23 (b) As part of the competitive procurement process, the
21-24 corporation shall evaluate the demonstrated capacity of any third
21-25 party administrator to administer programs of similar size and
21-26 complexity.
21-27 Sec. 109.206. REPORTING AND ACCOUNTABILITY. (a) The
22-1 corporation shall report to the commission as required by the
22-2 commission with respect to coverage and services provided under
22-3 this subchapter.
22-4 (b) The commission shall establish a procedure to monitor
22-5 the provision of coverage and services under this subchapter.
22-6 SECTION 3. Section 4, Article 3.51-6, Insurance Code, is
22-7 amended to read as follows:
22-8 Sec. 4. EXEMPTIONS. The provisions of this article shall
22-9 not be applicable to:
22-10 (1) credit accident and health insurance policies
22-11 subject to Article 3.53 of the Insurance Code, as amended;
22-12 (2) any group specifically provided for or authorized
22-13 by law in existence and covered under a policy filed with the State
22-14 Board of Insurance prior to April 1, 1975;
22-15 (3) accident and health coverages that are incidental
22-16 to any form of group automobile, casualty, property, or workmen's
22-17 compensation--employers' liability policies promulgated or approved
22-18 by the State Board of Insurance;
22-19 (4) any policy or contract of insurance with a state
22-20 agency, department, or board providing health services to [all]
22-21 eligible persons under Chapter 32, Human Resources Code, or in
22-22 accordance with 42 U.S.C. Sections 1396-1396g, as amended, or 42
22-23 U.S.C. Section 1397aa et seq., as amended, [Section 6, The Medical
22-24 Assistance Act of 1967, as amended (Article 695j--1, Vernon's Texas
22-25 Civil Statutes), 343-353 (42 U.S.C.A. 1396-1396g), providing health
22-26 care and services] under a state plan.
22-27 SECTION 4. Not later than September 1, 1999, the Health and
23-1 Human Services Commission shall:
23-2 (1) develop the child health plan required under
23-3 Chapter 62, Health and Safety Code, as added by this Act; and
23-4 (2) submit for approval a plan amendment relating to
23-5 the child health plan under 42 U.S.C. Section 1397ff, as amended.
23-6 SECTION 5. If, before implementing any provision of Chapter
23-7 62 or 63, Health and Safety Code, as added by this Act, the Health
23-8 and Human Services Commission determines that a waiver or
23-9 authorization from a federal agency is necessary for implementation
23-10 of that provision, the commission shall request the waiver or
23-11 authorization and may delay implementing that provision until the
23-12 waiver or authorization is granted.
23-13 SECTION 6. The first money becoming available to the state
23-14 each fiscal year as a result of the Comprehensive Settlement
23-15 Agreement and Release filed in the case styled The State of Texas
23-16 v. The American Tobacco Co., et al., No. 5-96CV-91, in the United
23-17 States District Court, Eastern District of Texas, shall be used to
23-18 fund the child health plan program established by this state under
23-19 Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et
23-20 seq.), as amended.
23-21 SECTION 7. The standing or other committees of the House of
23-22 Representatives and Senate of the 76th Legislature that have
23-23 jurisdiction over the Health and Human Services Commission and
23-24 other agencies related to the implementation of Chapter 62, Health
23-25 and Safety Code, as added by this Act, as identified by the speaker
23-26 of the house of representatives and the lieutenant governor, shall:
23-27 (1) monitor the implementation of Chapter 62, Health
24-1 and Safety Code, as added by this Act; and
24-2 (2) perform other related duties as required by the
24-3 speaker of the house of representatives and lieutenant governor, as
24-4 appropriate.
24-5 SECTION 8. (a) Not later than September 1, 2000, the Health
24-6 and Human Services Commission shall establish and implement the
24-7 health benefits plan coverage program required by Chapter 63,
24-8 Health and Safety Code, as added by this Act.
24-9 (b) The commission may delay implementation of the health
24-10 benefits plan coverage program until a plan amendment relating to
24-11 the child health plan under 42 U.S.C. Section 1397ff, as amended,
24-12 is approved.
24-13 SECTION 9. The state shall provide coverage under the state
24-14 Medicaid program or under a program established under Title XXI of
24-15 the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
24-16 amended, to a child described by Section 63.002, Health and Safety
24-17 Code, as added by this Act, if the federal government authorizes
24-18 the state to provide that coverage. The Health and Human Services
24-19 Commission or any other appropriate agency shall comply with any
24-20 prerequisites under the federal law to providing the coverage.
24-21 SECTION 10. The importance of this legislation and the
24-22 crowded condition of the calendars in both houses create an
24-23 emergency and an imperative public necessity that the
24-24 constitutional rule requiring bills to be read on three several
24-25 days in each house be suspended, and this rule is hereby suspended,
24-26 and that this Act take effect and be in force from and after its
24-27 passage, and it is so enacted.