1-1 By: Moncrief, et al. S.B. No. 445
1-2 (In the Senate - Filed February 9, 1999; February 10, 1999,
1-3 read first time and referred to Committee on Health Services;
1-4 March 8, 1999, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 5, Nays 0; March 8, 1999,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 445 By: Moncrief
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to a child health plan for certain low-income children.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. Subtitle C, Title 2, Health and Safety Code, is
1-13 amended by adding Chapter 62 to read as follows:
1-14 CHAPTER 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN
1-15 SUBCHAPTER A. GENERAL PROVISIONS
1-16 Sec. 62.001. DEFINITIONS. In this chapter:
1-17 (1) "Commission" means the Health and Human Services
1-18 Commission.
1-19 (2) "Commissioner" means the commissioner of health
1-20 and human services.
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
1-25 the time that federal funding terminates under Title XXI of the
1-26 Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended,
1-27 or another law providing federal funding for a state-designed child
1-28 health plan.
1-29 (Sections 62.003 to 62.050 reserved for expansion
1-30 SUBCHAPTER B. ADMINISTRATION OF CHILD HEALTH PLAN PROGRAM
1-31 Sec. 62.051. DUTIES OF COMMISSION. (a) The commission
1-32 shall develop a state-designed child health plan program to obtain
1-33 health benefits coverage for children in low-income families. The
1-34 commission shall ensure that the child health plan program is
1-35 designed and administered in a manner that qualifies for federal
1-36 funding under Title XXI of the Social Security Act (42 U.S.C.
1-37 Section 1397aa et seq.), as amended, and any other applicable law
1-38 or regulations.
1-39 (b) The commission shall oversee the implementation of the
1-40 child health plan program and coordinate the activities of each
1-41 agency necessary to the implementation of the program, including
1-42 the Texas Department of Health, Texas Department of Human Services,
1-43 and Texas Department of Insurance.
1-44 (c) The commission may adopt rules as necessary to implement
1-45 this chapter. The commission may require the Texas Department of
1-46 Health, the Texas Department of Human Services, or any other health
1-47 and human services agency to adopt, with the approval of the
1-48 commission, any rules that may be adopted under this subsection.
1-49 With the consent of another agency, including the Texas Department
1-50 of Insurance, the commission may delegate to that agency the
1-51 authority to adopt, with the approval of the commission, any rules
1-52 that may be adopted under this subsection.
1-53 Sec. 62.052. DUTIES OF TEXAS DEPARTMENT OF HEALTH. (a) The
1-54 Texas Department of Health shall administer the child health plan
1-55 under the direction of the commission. The department shall:
1-56 (1) implement contracts with child health plan
1-57 providers under Section 62.155;
1-58 (2) monitor the providers, through reporting
1-59 requirements and other means, to ensure performance under the
1-60 contracts and quality delivery of services; and
1-61 (3) provide payment under the contracts to the
1-62 providers.
1-63 (b) The commission, or the Texas Department of Health under
1-64 the direction of and in consultation with the commission, may adopt
2-1 rules as necessary to implement this section.
2-2 Sec. 62.053. DUTIES OF TEXAS DEPARTMENT OF HUMAN SERVICES.
2-3 (a) Under the direction of the commission, the Texas Department of
2-4 Human Services shall:
2-5 (1) accept applications for coverage under the child
2-6 health plan and implement the child health plan program eligibility
2-7 screening and enrollment procedures;
2-8 (2) resolve grievances relating to eligibility
2-9 determinations; and
2-10 (3) coordinate the child health plan program with the
2-11 Medicaid program.
2-12 (b) If the commission contracts with a third party
2-13 administrator under Section 62.055, the Texas Department of Human
2-14 Services, under the direction of the commission, shall:
2-15 (1) implement the contract;
2-16 (2) monitor the third party administrator, through
2-17 reporting requirements and other means, to ensure performance under
2-18 the contract and quality delivery of services; and
2-19 (3) provide payment under the contract to the third
2-20 party administrator.
2-21 (c) The commission, or the Texas Department of Human
2-22 Services under the direction of and in consultation with the
2-23 commission, may adopt rules as necessary to implement this section.
2-24 Sec. 62.054. DUTIES OF TEXAS DEPARTMENT OF INSURANCE.
2-25 (a) At the request of the commission, the Texas Department of
2-26 Insurance shall provide any necessary assistance with the
2-27 development of the child health plan. The department shall monitor
2-28 the quality of the services provided by health benefit plan
2-29 providers and resolve grievances relating to the providers.
2-30 (b) The commission and the Texas Department of Insurance may
2-31 adopt a memorandum of understanding that addresses the
2-32 responsibilities of each agency in developing the plan.
2-33 (c) The Texas Department of Insurance, in consultation with
2-34 the commission, may adopt rules as necessary to implement this
2-35 section.
2-36 Sec. 62.055. CONTRACTS FOR IMPLEMENTATION OF CHILD HEALTH
2-37 PLAN. (a) In administering the child health plan, the commission
2-38 may contract with:
2-39 (1) a third party administrator to provide enrollment
2-40 and related services under the state child health plan; or
2-41 (2) another entity, including the Texas Healthy Kids
2-42 Corporation under Subchapter F, Chapter 109, to obtain health
2-43 benefit plan coverage for children who are eligible for coverage
2-44 under the state child health plan.
2-45 (b) A third party administrator or other entity may perform
2-46 tasks under the contract that would otherwise be performed by the
2-47 Texas Department of Health or Texas Department of Human Services
2-48 under this chapter.
2-49 (c) If the commission enters into a contract with an entity
2-50 described by Subsection (a)(2), the commission may require the
2-51 Texas Department of Health or the Texas Department of Human
2-52 Services, as the commission determines appropriate, to:
2-53 (1) implement the contract with the entity;
2-54 (2) monitor the entity, through reporting requirements
2-55 and other means, to ensure performance under the contract and
2-56 quality delivery of services; and
2-57 (3) provide payment under the contract.
2-58 Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.
2-59 (a) The commission shall conduct a community outreach and
2-60 education campaign to provide information relating to the
2-61 availability of health benefits for children under this chapter.
2-62 The commission shall conduct the campaign in coordination with the
2-63 Texas Healthy Kids Corporation in a manner that promotes the goals
2-64 of both programs and minimizes duplication of effort.
2-65 (b) The community outreach campaign must include a toll-free
2-66 telephone number through which families may obtain information
2-67 about health benefits coverage for children.
2-68 (c) The commission may provide grants to community-based
2-69 organizations to implement the community outreach campaign.
3-1 (d) The commission may direct that the Texas Department of
3-2 Health or the Texas Department of Human Services perform all or
3-3 part of the community outreach campaign.
3-4 (Sections 62.057 to 62.100 reserved for expansion
3-5 SUBCHAPTER C. ELIGIBILITY FOR COVERAGE UNDER CHILD HEALTH PLAN
3-6 Sec. 62.101. ELIGIBILITY. (a) A child is eligible for
3-7 health benefits coverage under the child health plan if the child:
3-8 (1) is younger than 19 years of age;
3-9 (2) is not eligible for medical assistance under the
3-10 Medicaid program;
3-11 (3) is not covered by a health benefits plan offering
3-12 adequate benefits, as determined by the commission;
3-13 (4) has a family income that is less than or equal to
3-14 the income eligibility level established under Subsection (b); and
3-15 (5) satisfies any other eligibility standard imposed
3-16 under the child health plan program in accordance with 42 U.S.C.
3-17 Section 1397bb, as amended, and any other applicable law or
3-18 regulations.
3-19 (b) The commission shall establish income eligibility levels
3-20 consistent with Title XXI of the Social Security Act (42 U.S.C.
3-21 Section 1397aa et seq.), as amended, and any other applicable law
3-22 or regulations, and subject to the availability of appropriated
3-23 money. At the implementation of the program, children ages birth
3-24 through 10 years of age whose net family income is at or below 200
3-25 percent of the federal poverty level shall be eligible for health
3-26 benefits coverage. Children ages 11 through 18 years of age whose
3-27 net family income is at or below 150 percent of the federal poverty
3-28 level shall also be eligible. In this subsection, "net family
3-29 income" includes offsets for such expenses as child care and
3-30 work-related expenses consistent with Medicaid standards.
3-31 (c) The commissioner shall evaluate enrollment levels and
3-32 program impact every six months during the first 12 months of
3-33 implementation and at least annually thereafter and shall submit a
3-34 finding of fact to the Legislative Budget Board and the Governor's
3-35 Office of Budget and Planning as to the adequacy of funding and the
3-36 ability of the program to sustain enrollment at higher income
3-37 eligibility levels for children ages 11 through 18 years of age.
3-38 The commissioner shall adjust the income limit to a higher level
3-39 after submittal of a finding of fact that funding for the child
3-40 health plan is sufficient to support and sustain enrollment at the
3-41 higher level.
3-42 (d) Prior to implementation of the program and on an annual
3-43 basis thereafter, the commissioner shall evaluate enrollment levels
3-44 and program impact and submit a finding of fact to the Legislative
3-45 Budget Board and the Governor's Office of Budget and Planning as to
3-46 the adequacy of funding and the ability of the program to sustain
3-47 enrollment of children ages eight through 10 whose family income is
3-48 between 150 percent and 200 percent of the federal poverty level.
3-49 The commissioner shall adjust the income limit to a lower level
3-50 after submittal of a finding of fact that funding for the child
3-51 health plan is not sufficient to sustain enrollment at the higher
3-52 level.
3-53 Sec. 62.102. CONTINUOUS COVERAGE. The commission by rule
3-54 may provide that an individual who is determined to be eligible for
3-55 coverage under the child health plan remains eligible for those
3-56 benefits until the earlier of:
3-57 (1) the end of a period, not to exceed 12 months,
3-58 following the date of the eligibility determination; or
3-59 (2) the individual's 19th birthday.
3-60 Sec. 62.103. APPLICATION FORM AND PROCEDURES. (a) The
3-61 commission, or the Texas Department of Human Services at the
3-62 direction of and in consultation with the commission, shall adopt
3-63 an application form and application procedures for requesting child
3-64 health plan coverage under this chapter.
3-65 (b) To the extent possible, the form and procedures must be
3-66 coordinated with forms and procedures under the Medicaid program
3-67 and forms and procedures used by the Texas Healthy Kids Corporation
3-68 so that a person may submit a single consolidated application to
3-69 seek assistance under this chapter or the Medicaid program or from
4-1 the corporation.
4-2 (c) The commission may permit application to be made by
4-3 mail, over the telephone, or through the Internet.
4-4 Sec. 62.104. ELIGIBILITY SCREENING AND ENROLLMENT. (a) The
4-5 commission, or the Texas Department of Human Services at the
4-6 direction and in consultation with the commission, shall develop
4-7 eligibility screening and enrollment procedures for children that
4-8 comply with the requirements of 42 U.S.C. Section 1397bb, as
4-9 amended, and any other applicable law or regulations. The
4-10 procedures shall ensure that Medicaid-eligible children are
4-11 identified and referred to the Medicaid program.
4-12 (b) The Texas Integrated Enrollment Services eligibility
4-13 determination system or a compatible system may be used to screen
4-14 and enroll children under the child health plan.
4-15 (Sections 62.105 to 62.150 reserved for expansion
4-16 SUBCHAPTER D. CHILD HEALTH PLAN
4-17 Sec. 62.151. CHILD HEALTH PLAN COVERAGE. (a) The child
4-18 health plan must comply with this chapter and the coverage
4-19 requirements prescribed by 42 U.S.C. Section 1397cc, as amended,
4-20 and any other applicable law or regulations.
4-21 (b) In developing the plan, the commission shall consider
4-22 the health care needs of healthy children and children with special
4-23 health care needs. The commission shall also consider the health
4-24 benefit plans providing coverage to state employees under the Texas
4-25 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
4-26 Vernon's Texas Insurance Code) and may use a health benefit plan
4-27 providing coverage under that article as a model for the child
4-28 health plan. The benefits offered under the child health plan may
4-29 vary from the benefits offered state employees.
4-30 (c) The child health plan must allow an enrolled child with
4-31 a chronic, disabling, or life-threatening illness to select an
4-32 appropriate specialist as a primary care physician.
4-33 Sec. 62.152. APPLICATION OF INSURANCE LAW. To provide the
4-34 flexibility necessary to satisfy the requirements of Title XXI of
4-35 the Social Security Act (42 U.S.C. Section 1397aa et seq.), as
4-36 amended, and any other applicable law or regulations, the child
4-37 health plan is not subject to a law that requires:
4-38 (1) coverage or the offer of coverage of a health care
4-39 service or benefit;
4-40 (2) coverage or the offer of coverage for the
4-41 provision of services by a particular health care services
4-42 provider; or
4-43 (3) the use of a particular policy or contract form or
4-44 of particular language in a policy or contract form.
4-45 Sec. 62.153. COST SHARING. (a) To the extent permitted
4-46 under 42 U.S.C. Section 1397cc, as amended, and any other
4-47 applicable law or regulations, the commission shall require
4-48 enrollees to share the cost of the child health plan, including
4-49 provisions requiring enrollees under the child health plan to pay:
4-50 (1) a copayment for services provided under the plan;
4-51 (2) an enrollment fee; or
4-52 (3) a portion of the plan premium.
4-53 (b) Cost-sharing provisions adopted under this section shall
4-54 ensure that families with higher levels of income are required to
4-55 pay progressively higher percentages of the cost of the plan.
4-56 (c) If cost-sharing provisions imposed under Subsection (a)
4-57 include requirements that enrollees pay a portion of the plan
4-58 premium, the commission shall specify the manner in which the
4-59 premium is paid. The commission may require that the premium be
4-60 paid to the Texas Department of Health, the Texas Department of
4-61 Human Services, or the child health plan provider.
4-62 Sec. 62.154. CROWD OUT. To the extent permitted under Title
4-63 XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.),
4-64 as amended, and any other applicable law or regulations, the child
4-65 health plan may include waiting periods, copayments, and other
4-66 provisions intended to discourage:
4-67 (1) employers and other persons from electing to
4-68 discontinue offering coverage for children under employee or other
4-69 group health benefit plans; and
5-1 (2) individuals with access to adequate health benefit
5-2 plan coverage, other than coverage under the child health plan,
5-3 from electing not to obtain or to discontinue that coverage for a
5-4 child.
5-5 Sec. 62.155. CHILD HEALTH PLAN PROVIDERS. (a) The
5-6 commission, or the Texas Department of Health at the direction of
5-7 and in consultation with the commission, shall select the child
5-8 health plan providers under the program through open enrollment or
5-9 a competitive bid process. A child health plan provider:
5-10 (1) must hold a certificate of authority or other
5-11 appropriate license issued by the Texas Department of Insurance
5-12 that authorizes the provider to provide the type of child health
5-13 plan offered and must satisfy, except as provided by this chapter,
5-14 any applicable requirement of the Insurance Code or another
5-15 insurance law of this state; or
5-16 (2) in the case of an individual health care provider,
5-17 must satisfy such certification and licensure requirements as the
5-18 commission may determine, consistent with state law.
5-19 (b) In selecting a child health plan provider, the
5-20 commission may give preference to a person who provides similar
5-21 coverage under the Medicaid program or through the Texas Healthy
5-22 Kids Corporation.
5-23 (Sections 62.156 to 62.200 reserved for expansion
5-24 SUBCHAPTER E. LEGISLATIVE OVERSIGHT
5-25 Sec. 62.201. DEFINITION. In this subchapter, "committee"
5-26 means the child health plan legislative oversight committee.
5-27 Sec. 62.202. COMPOSITION OF COMMITTEE; PRESIDING OFFICER.
5-28 (a) The committee is composed of:
5-29 (1) two members of the senate and one public member
5-30 appointed by the lieutenant governor; and
5-31 (2) two members of the house of representatives and
5-32 one public member appointed by the speaker of the house of
5-33 representatives.
5-34 (b) A member of the committee serves at the pleasure of the
5-35 appointing official.
5-36 (c) The lieutenant governor and the speaker of the house of
5-37 representatives shall appoint the presiding officer of the
5-38 committee on an alternating basis. The presiding officer serves a
5-39 two-year term expiring August 31 of each odd-numbered year.
5-40 Sec. 62.203. COMMITTEE POWERS AND DUTIES. (a) The
5-41 committee shall:
5-42 (1) meet at the call of the presiding officer;
5-43 (2) receive information about rules proposed or
5-44 adopted under this chapter; and
5-45 (3) review specific recommendations for legislation
5-46 proposed by the commission relating to administration of the child
5-47 health plan program.
5-48 (b) The committee may issue process, in accordance with
5-49 Section 301.024, Government Code, to compel the attendance of
5-50 witnesses and the production of books, records, documents, and
5-51 instruments required by the committee.
5-52 (c) The committee shall monitor the effectiveness and
5-53 efficiency of the child health plan program under this chapter.
5-54 (d) The commission and the Texas Department of Health shall
5-55 report quarterly to the committee on implementation and
5-56 administration of the child health plan program and the use of
5-57 money appropriated for the program. The committee may request
5-58 additional reports and other information relating to the child
5-59 health plan program from:
5-60 (1) the commission;
5-61 (2) the Texas Department of Health, the Texas
5-62 Department of Human Services, and any other health and human
5-63 services agency; and
5-64 (3) the Texas Department of Insurance and any other
5-65 agency necessary to the implementation of the child health plan
5-66 program.
5-67 (e) The committee shall use the existing staff resources of
5-68 the senate and the house of representatives to assist the committee
5-69 in performing its duties under this subchapter.
6-1 Sec. 62.204. REPORT. (a) The committee shall report to the
6-2 governor, lieutenant governor, and speaker of the house of
6-3 representatives not later than November 15 of each even-numbered
6-4 year.
6-5 (b) The report must include:
6-6 (1) identification of significant problems in the
6-7 administration of the child health plan program, with
6-8 recommendations for action;
6-9 (2) an analysis of the effectiveness and efficiency of
6-10 administration of the child health plan program, with
6-11 recommendations for any necessary research;
6-12 (3) an analysis of the delivery of health care
6-13 services to children in low-income families in this state; and
6-14 (4) recommendations for legislative action.
6-15 Sec. 62.205. RIGHTS OF EMPLOYEES; RETALIATION PROHIBITED.
6-16 (a) In this section, "personnel action" has the meaning assigned
6-17 by Section 554.001, Government Code.
6-18 (b) An employee of any agency described by Section 62.203(d)
6-19 may cooperate with the committee in the performance of its
6-20 functions.
6-21 (c) The agency may not suspend or terminate the employment
6-22 of, or take another adverse personnel action against, an employee
6-23 of the agency solely because the employee cooperates with the
6-24 committee in good faith.
6-25 Sec. 62.206. EXPIRATION. The committee is abolished and
6-26 this subchapter expires September 1, 2003.
6-27 SECTION 2. Chapter 109, Health and Safety Code, is amended
6-28 by adding Subchapter F to read as follows:
6-29 SUBCHAPTER F. STATE CHILD HEALTH PLAN
6-30 Sec. 109.201. DEFINITIONS. In this subchapter:
6-31 (1) "Commission" means the Health and Human Services
6-32 Commission.
6-33 (2) "State child health plan" means the child health
6-34 plan program established under Chapter 62.
6-35 Sec. 109.202. CHILD HEALTH PLAN COVERAGE. (a) The
6-36 commission may use appropriated funds, in accordance with the
6-37 General Appropriations Act, to purchase coverage under a health
6-38 benefit plan provided through the corporation for children who are
6-39 eligible for coverage under the state child health plan and to
6-40 contract with the corporation for other services under this
6-41 subchapter.
6-42 (b) State child health plan coverage offered under this
6-43 subchapter must be approved by the commission. The commission
6-44 shall ensure that coverage provided under this subchapter complies
6-45 with Chapter 62.
6-46 Sec. 109.203. ELIGIBILITY. Notwithstanding any other
6-47 provision of this chapter or the eligibility criteria established
6-48 under Section 109.061, an individual who is eligible for coverage
6-49 under the state child health plan, as determined by the commission,
6-50 is eligible for coverage provided through the corporation under
6-51 this subchapter.
6-52 Sec. 109.204. COMMUNITY OUTREACH; ELIGIBILITY SCREENING.
6-53 (a) In connection with offering state child health plan coverage
6-54 under this subchapter, the corporation, under the direction of the
6-55 commission, may:
6-56 (1) conduct all or part of the community outreach and
6-57 education campaign required under Section 62.056; and
6-58 (2) perform eligibility screening and enrollment
6-59 services.
6-60 (b) The eligibility screening and enrollment procedures used
6-61 by the corporation must comply with Chapter 62.
6-62 Sec. 109.205. REPORTING AND ACCOUNTABILITY. (a) The
6-63 corporation shall report to the commission as required by the
6-64 commission or the agency designated under Section 62.055(c) with
6-65 respect to coverage and services provided under this subchapter.
6-66 (b) The commission or the agency designated under Section
6-67 62.055(c) shall establish a procedure to monitor the provision of
6-68 coverage and services under this subchapter.
6-69 SECTION 3. Section 4, Article 3.51-6, Insurance Code, is
7-1 amended to read as follows:
7-2 Sec. 4. EXEMPTIONS. The provisions of this article shall
7-3 not be applicable to:
7-4 (1) credit accident and health insurance policies
7-5 subject to Article 3.53 of the Insurance Code, as amended;
7-6 (2) any group specifically provided for or authorized
7-7 by law in existence and covered under a policy filed with the State
7-8 Board of Insurance prior to April 1, 1975;
7-9 (3) accident and health coverages that are incidental
7-10 to any form of group automobile, casualty, property, or workmen's
7-11 compensation--employers' liability policies promulgated or approved
7-12 by the State Board of Insurance;
7-13 (4) any policy or contract of insurance with a state
7-14 agency, department, or board providing health services to [all]
7-15 eligible persons under Chapter 32, Human Resources Code, or in
7-16 accordance with 42 U.S.C. Sections 1396-1396g, as amended, or 42
7-17 U.S.C. Section 1397aa et seq., as amended, [Section 6, The Medical
7-18 Assistance Act of 1967, as amended (Article 695j--1, Vernon's Texas
7-19 Civil Statutes), 343-353 (42 U.S.C.A. 1396-1396g), providing health
7-20 care and services] under a state plan.
7-21 SECTION 4. Not later than September 1, 1999, the Health and
7-22 Human Services Commission shall:
7-23 (1) develop the child health plan required under
7-24 Chapter 62, Health and Safety Code, as added by this Act; and
7-25 (2) submit for approval a plan amendment relating to
7-26 the child health plan under 42 U.S.C. Section 1397ff, as amended.
7-27 SECTION 5. If, before implementing any provision of Chapter
7-28 62, Health and Safety Code, as added by this Act, the Health and
7-29 Human Services Commission determines that a waiver or authorization
7-30 from a federal agency is necessary for implementation of that
7-31 provision, the commission shall request the waiver or authorization
7-32 and may delay implementing that provision until the waiver or
7-33 authorization is granted.
7-34 SECTION 6. The importance of this legislation and the
7-35 crowded condition of the calendars in both houses create an
7-36 emergency and an imperative public necessity that the
7-37 constitutional rule requiring bills to be read on three several
7-38 days in each house be suspended, and this rule is hereby suspended,
7-39 and that this Act take effect and be in force from and after its
7-40 passage, and it is so enacted.
7-41 * * * * *