By Moncrief S.B. No. 445
76R5883 DLF-D
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 Chapter 62 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. DEFINITION. In this chapter, "commission"
1-9 means the Health and Human Services Commission.
1-10 Sec. 62.002. NOT AN ENTITLEMENT. This chapter does not
1-11 establish an entitlement to assistance in obtaining health benefits
1-12 for a child.
1-13 (Sections 62.003-62.050 reserved for expansion
1-14 SUBCHAPTER B. ADMINISTRATION OF CHILD HEALTH PLAN PROGRAM
1-15 Sec. 62.051. DUTIES OF COMMISSION. (a) The commission
1-16 shall develop a state-designed child health plan program to obtain
1-17 health benefits coverage for children in low-income families. The
1-18 commission shall ensure that the child health plan program is
1-19 designed and administered in a manner that qualifies for federal
1-20 funding under Title XXI of the Social Security Act (42 U.S.C.
1-21 Section 1397aa et seq.), as amended, and any other applicable law
1-22 or regulations.
1-23 (b) The commission shall oversee the implementation of the
1-24 child health plan program and coordinate the activities of each
2-1 agency necessary to the implementation of the program, including
2-2 the Texas Department of Health, Texas Department of Human Services,
2-3 and Texas Department of Insurance.
2-4 (c) The commission may adopt rules as necessary to implement
2-5 this chapter. The commission may require the Texas Department of
2-6 Health, the Texas Department of Human Services, or any other health
2-7 and human services agency to adopt, with the approval of the
2-8 commission, any rules that may be adopted under this subsection.
2-9 With the consent of another agency, including the Texas Department
2-10 of Insurance, the commission may delegate to that agency the
2-11 authority to adopt, with the approval of the commission, any rules
2-12 that may be adopted under this subsection.
2-13 Sec. 62.052. DUTIES OF TEXAS DEPARTMENT OF HEALTH. (a) The
2-14 Texas Department of Health shall administer the child health plan
2-15 under the direction of the commission. The department shall:
2-16 (1) implement contracts with child health plan
2-17 providers under Section 62.155;
2-18 (2) monitor the providers, through reporting
2-19 requirements and other means, to ensure performance under the
2-20 contracts and quality delivery of services; and
2-21 (3) provide payment under the contracts to the
2-22 providers.
2-23 (b) The commission, or the Texas Department of Health under
2-24 the direction of and in consultation with the commission, may adopt
2-25 rules as necessary to implement this section.
2-26 Sec. 62.053. DUTIES OF TEXAS DEPARTMENT OF HUMAN SERVICES.
2-27 (a) Under the direction of the commission, the Texas Department of
3-1 Human Services shall:
3-2 (1) accept applications for coverage under the child
3-3 health plan and implement the child health plan program eligibility
3-4 screening and enrollment procedures;
3-5 (2) resolve grievances relating to eligibility
3-6 determinations; and
3-7 (3) coordinate the child health plan program with the
3-8 Medicaid program.
3-9 (b) If the commission contracts with a third party
3-10 administrator under Section 62.055, the Texas Department of Human
3-11 Services, under the direction of the commission, shall:
3-12 (1) implement the contract;
3-13 (2) monitor the third party administrator, through
3-14 reporting requirements and other means, to ensure performance under
3-15 the contract and quality delivery of services; and
3-16 (3) provide payment under the contract to the third
3-17 party administrator.
3-18 (c) The commission, or the Texas Department of Human
3-19 Services under the direction of and in consultation with the
3-20 commission, may adopt rules as necessary to implement this section.
3-21 Sec. 62.054. DUTIES OF TEXAS DEPARTMENT OF INSURANCE. (a)
3-22 At the request of the commission, the Texas Department of Insurance
3-23 shall provide any necessary assistance with the development of the
3-24 child health plan. The department shall monitor the quality of the
3-25 services provided by health benefit plan providers and resolve
3-26 grievances relating to the providers.
3-27 (b) The commission and the Texas Department of Insurance may
4-1 adopt a memorandum of understanding that addresses the
4-2 responsibilities of each agency in developing the plan.
4-3 (c) The Texas Department of Insurance, in consultation with
4-4 the commission, may adopt rules as necessary to implement this
4-5 section.
4-6 Sec. 62.055. THIRD PARTY ADMINISTRATOR. The commission may
4-7 contract with a third party administrator to provide enrollment
4-8 services under the child health plan program. The third party
4-9 administrator may perform tasks under the contract that would
4-10 otherwise be performed by the Texas Department of Human Services
4-11 under this chapter.
4-12 Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.
4-13 (a) The commission shall conduct a community outreach and
4-14 education campaign to provide information relating to the
4-15 availability of health benefits for children under this chapter.
4-16 The commission shall conduct the campaign in coordination with the
4-17 Texas Healthy Kids Corporation in a manner that promotes the goals
4-18 of both programs and minimizes duplication of effort.
4-19 (b) The community outreach campaign must include a toll-free
4-20 telephone number through which families may obtain information
4-21 about health benefits coverage for children.
4-22 (c) The commission may provide grants to community-based
4-23 organizations to implement the community outreach campaign.
4-24 (d) The commission may direct that the Texas Department of
4-25 Health or the Texas Department of Human Services perform all or
4-26 part of the community outreach campaign.
4-27 (Sections 62.057-62.100 reserved for expansion
5-1 SUBCHAPTER C. ELIGIBILITY FOR COVERAGE UNDER CHILD HEALTH PLAN
5-2 Sec. 62.101. ELIGIBILITY. (a) A child is eligible for
5-3 health benefits coverage under the child health plan if the child:
5-4 (1) is younger than 19 years of age;
5-5 (2) is not eligible for medical assistance under the
5-6 Medicaid program;
5-7 (3) is not covered by a health benefits plan offering
5-8 adequate benefits, as determined by the commission;
5-9 (4) has a family income that is less than or equal to
5-10 the income eligibility level established under Subsection (b); and
5-11 (5) satisfies any other eligibility standard imposed
5-12 under the child health plan program in accordance with 42 U.S.C.
5-13 Section 1397bb, as amended, and any other applicable law or
5-14 regulations.
5-15 (b) The commission shall establish an income eligibility
5-16 level consistent with Title XXI of the Social Security Act (42
5-17 U.S.C. Section 1397aa et seq.), as amended, and any other
5-18 applicable law or regulations, and subject to the availability of
5-19 appropriated money. The income eligibility level may not be set at
5-20 a level higher than 200 percent of the federal poverty level based
5-21 on the federal Office of Management and Budget poverty index.
5-22 Sec. 62.102. CONTINUOUS COVERAGE. The commission by rule
5-23 may provide that an individual who is determined to be eligible for
5-24 coverage under the child health plan remains eligible for those
5-25 benefits until the earlier of:
5-26 (1) the end of a period, not to exceed 12 months,
5-27 following the date of the eligibility determination; or
6-1 (2) the individual's 19th birthday.
6-2 Sec. 62.103. APPLICATION FORM AND PROCEDURES. (a) The
6-3 commission, or the Texas Department of Human Services at the
6-4 direction of and in consultation with the commission, shall adopt
6-5 an application form and application procedures for requesting child
6-6 health plan coverage under this chapter.
6-7 (b) To the extent possible, the form and procedures must be
6-8 coordinated with forms and procedures under the Medicaid program
6-9 and forms and procedures used by the Texas Healthy Kids Corporation
6-10 so that a person may submit a single consolidated application to
6-11 seek assistance under this chapter or the Medicaid program or from
6-12 the corporation.
6-13 (c) The commission may permit application to be made by
6-14 mail, over the telephone, or through the Internet.
6-15 Sec. 62.104. ELIGIBILITY SCREENING AND ENROLLMENT. (a) The
6-16 commission, or the Texas Department of Human Services at the
6-17 direction and in consultation with the commission, shall develop
6-18 eligibility screening and enrollment procedures for children that
6-19 comply with the requirements of 42 U.S.C. Section 1397bb, as
6-20 amended, and any other applicable law or regulations. The
6-21 procedures shall ensure that Medicaid-eligible children are
6-22 identified and referred to the Medicaid program.
6-23 (b) The Texas Integrated Enrollment Services eligibility
6-24 determination system or a compatible system may be used to screen
6-25 and enroll children under the child health plan.
6-26 (Sections 62.105-62.150 reserved for expansion
6-27 SUBCHAPTER D. CHILD HEALTH PLAN
7-1 Sec. 62.151. CHILD HEALTH PLAN COVERAGE. (a) The child
7-2 health plan must comply with this chapter and the coverage
7-3 requirements prescribed by 42 U.S.C. Section 1397cc, as amended,
7-4 and any other applicable law or regulations.
7-5 (b) In developing the plan, the commission shall consider
7-6 the health care needs of healthy children and children with special
7-7 health care needs. The commission shall also consider the health
7-8 benefit plans providing coverage to state employees under the Texas
7-9 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
7-10 Vernon's Texas Insurance Code) and may use a health benefit plan
7-11 providing coverage under that article as a model for the child
7-12 health plan. The benefits offered under the child health plan may
7-13 vary from the benefits offered state employees.
7-14 (c) The child health plan must allow an enrolled child with
7-15 a chronic, disabling, or life-threatening illness to select an
7-16 appropriate specialist as a primary care physician.
7-17 Sec. 62.152. APPLICATION OF INSURANCE LAW. To provide the
7-18 flexibility necessary to satisfy the requirements of Title XXI of
7-19 the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
7-20 amended, and any other applicable law or regulations, the child
7-21 health plan is not subject to a law that requires:
7-22 (1) coverage or the offer of coverage of a health care
7-23 service or benefit;
7-24 (2) coverage or the offer of coverage for the
7-25 provision of services by a particular health care services
7-26 provider; or
7-27 (3) the use of a particular policy or contract form or
8-1 of particular language in a policy or contract form.
8-2 Sec. 62.153. COST SHARING. (a) To the extent permitted
8-3 under 42 U.S.C. Section 1397cc, as amended, and any other
8-4 applicable law or regulations, the commission may require enrollees
8-5 to share the cost of the child health plan, including provisions
8-6 requiring enrollees under the child health plan to pay:
8-7 (1) a copayment for services provided under the plan;
8-8 (2) an enrollment fee; or
8-9 (3) a portion of the plan premium.
8-10 (b) If cost-sharing provisions imposed under Subsection (a)
8-11 include requirements that enrollees pay a portion of the plan
8-12 premium, the commission shall specify the manner in which the
8-13 premium is paid. The commission may require that the premium be
8-14 paid to the Texas Department of Health, the Texas Department of
8-15 Human Services, or the child health plan provider.
8-16 Sec. 62.154. CROWD OUT. To the extent permitted under Title
8-17 XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.),
8-18 as amended, and any other applicable law or regulations, the child
8-19 health plan may include waiting periods, copayments, and other
8-20 provisions intended to discourage:
8-21 (1) employers and other persons from electing to
8-22 discontinue offering coverage for children under employee or other
8-23 group health benefit plans; and
8-24 (2) individuals with access to adequate health benefit
8-25 plan coverage, other than coverage under the child health plan,
8-26 from electing not to obtain or to discontinue that coverage for a
8-27 child.
9-1 Sec. 62.155. CHILD HEALTH PLAN PROVIDERS. (a) The
9-2 commission, or the Texas Department of Health at the direction of
9-3 and in consultation with the commission, shall select the child
9-4 health plan providers under the program through a competitive bid
9-5 process. A child health plan provider must:
9-6 (1) hold a certificate of authority or other
9-7 appropriate license issued by the Texas Department of Insurance
9-8 that authorizes the provider to provide the type of child health
9-9 plan offered; and
9-10 (2) satisfy, except as provided by this chapter, any
9-11 applicable requirement of the Insurance Code or another insurance
9-12 law of this state.
9-13 (b) In selecting a child health plan provider, the
9-14 commission may give preference to a person who provides similar
9-15 coverage under the Medicaid program or through the Texas Healthy
9-16 Kids Corporation.
9-17 (Sections 62.156-62.200 reserved for expansion
9-18 SUBCHAPTER E. LEGISLATIVE OVERSIGHT
9-19 Sec. 62.201. DEFINITION. In this subchapter, "committee"
9-20 means the child health plan legislative oversight committee.
9-21 Sec. 62.202. COMPOSITION OF COMMITTEE; PRESIDING OFFICER.
9-22 (a) The committee is composed of:
9-23 (1) two members of the senate and one public member
9-24 appointed by the lieutenant governor; and
9-25 (2) two members of the house of representatives and
9-26 one public member appointed by the speaker of the house of
9-27 representatives.
10-1 (b) A member of the committee serves at the pleasure of the
10-2 appointing official.
10-3 (c) The lieutenant governor and the speaker of the house of
10-4 representatives shall appoint the presiding officer of the
10-5 committee on an alternating basis. The presiding officer serves a
10-6 two-year term expiring August 31 of each odd-numbered year.
10-7 Sec. 62.203. COMMITTEE POWERS AND DUTIES. (a) The
10-8 committee shall:
10-9 (1) meet at the call of the presiding officer;
10-10 (2) receive information about rules proposed or
10-11 adopted under this chapter; and
10-12 (3) review specific recommendations for legislation
10-13 proposed by the commission relating to administration of the child
10-14 health plan program.
10-15 (b) The committee may issue process, in accordance with
10-16 Section 301.024, Government Code, to compel the attendance of
10-17 witnesses and the production of books, records, documents, and
10-18 instruments required by the committee.
10-19 (c) The committee shall monitor the effectiveness and
10-20 efficiency of the child health plan program under this chapter.
10-21 (d) The commission and the Texas Department of Health shall
10-22 report quarterly to the committee on implementation and
10-23 administration of the child health plan program and the use of
10-24 money appropriated for the program. The committee may request
10-25 additional reports and other information relating to the child
10-26 health plan program from:
10-27 (1) the commission;
11-1 (2) the Texas Department of Health, the Texas
11-2 Department of Human Services, and any other health and human
11-3 services agency; and
11-4 (3) the Texas Department of Insurance and any other
11-5 agency necessary to the implementation of the child health plan
11-6 program.
11-7 (e) The committee shall use the existing staff resources of
11-8 the senate and the house of representatives to assist the committee
11-9 in performing its duties under this subchapter.
11-10 Sec. 62.204. REPORT. (a) The committee shall report to the
11-11 governor, lieutenant governor, and speaker of the house of
11-12 representatives not later than November 15 of each even-numbered
11-13 year.
11-14 (b) The report must include:
11-15 (1) identification of significant problems in the
11-16 administration of the child health plan program, with
11-17 recommendations for action;
11-18 (2) an analysis of the effectiveness and efficiency of
11-19 administration of the child health plan program, with
11-20 recommendations for any necessary research;
11-21 (3) an analysis of the delivery of health care
11-22 services to children in low-income families in this state; and
11-23 (4) recommendations for legislative action.
11-24 Sec. 62.205. RIGHTS OF EMPLOYEES; RETALIATION PROHIBITED.
11-25 (a) In this section, "personnel action" has the meaning assigned
11-26 by Section 554.001, Government Code.
11-27 (b) An employee of any agency described by Section 62.203(d)
12-1 may cooperate with the committee in the performance of its
12-2 functions.
12-3 (c) The agency may not suspend or terminate the employment
12-4 of, or take another adverse personnel action against, an employee
12-5 of the agency solely because the employee cooperates with the
12-6 committee in good faith.
12-7 Sec. 62.206. EXPIRATION. The committee is abolished and
12-8 this subchapter expires September 1, 2003.
12-9 SECTION 2. Section 4, Article 3.51-6, Insurance Code, is
12-10 amended to read as follows:
12-11 Sec. 4. EXEMPTIONS. The provisions of this article shall
12-12 not be applicable to:
12-13 (1) credit accident and health insurance policies
12-14 subject to Article 3.53 of the Insurance Code, as amended;
12-15 (2) any group specifically provided for or authorized
12-16 by law in existence and covered under a policy filed with the State
12-17 Board of Insurance prior to April 1, 1975;
12-18 (3) accident and health coverages that are incidental
12-19 to any form of group automobile, casualty, property, or workmen's
12-20 compensation--employers' liability policies promulgated or approved
12-21 by the State Board of Insurance;
12-22 (4) any policy or contract of insurance with a state
12-23 agency, department, or board providing health services to [all]
12-24 eligible persons under Chapter 32, Human Resources Code, or in
12-25 accordance with 42 U.S.C. Sections 1396-1396g, as amended, or 42
12-26 U.S.C. Section 1397aa et seq., as amended, [Section 6, The Medical
12-27 Assistance Act of 1967, as amended (Article 695j-1, Vernon's Texas
13-1 Civil Statutes), 343-353 (42 U.S.C.A. 1396-1396g), providing health
13-2 care and services] under a state plan.
13-3 SECTION 3. Not later than September 1, 1999, the Health and
13-4 Human Services Commission shall:
13-5 (1) develop the child health plan required under
13-6 Chapter 62, Health and Safety Code, as added by this Act; and
13-7 (2) submit for approval a plan amendment relating to
13-8 the child health plan under 42 U.S.C. Section 1397ff, as amended.
13-9 SECTION 4. If, before implementing any provision of Chapter
13-10 62, Health and Safety Code, as added by this Act, the Health and
13-11 Human Services Commission determines that a waiver or authorization
13-12 from a federal agency is necessary for implementation of that
13-13 provision, the commission shall request the waiver or authorization
13-14 and may delay implementing that provision until the waiver or
13-15 authorization is granted.
13-16 SECTION 5. The importance of this legislation and the
13-17 crowded condition of the calendars in both houses create an
13-18 emergency and an imperative public necessity that the
13-19 constitutional rule requiring bills to be read on three several
13-20 days in each house be suspended, and this rule is hereby suspended,
13-21 and that this Act take effect and be in force from and after its
13-22 passage, and it is so enacted.