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.