By Kitchen H.B. No. 1044
77R5381 JAT-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefits coverage for certain children.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 ARTICLE 1. EXPANSION OF STATE CHILD HEALTH PLAN COVERAGE
1-5 SECTION 1.01. Section 62.051, Health and Safety Code, is
1-6 amended by adding Subsection (g) to read as follows:
1-7 (g) The commission may apply for, receive, and administer
1-8 gifts, grants, loans, and other funds available from any source for
1-9 the state child health plan eligibility group B account under
1-10 Section 62.202.
1-11 SECTION 1.02. Subchapter C, Chapter 62, Health and Safety
1-12 Code, is amended by amending Section 62.101 and adding Sections
1-13 62.1015, 62.1016, and 62.1017 to read as follows:
1-14 Sec. 62.101. ELIGIBILITY GROUP A: NET FAMILY INCOME AT OR
1-15 BELOW 200 PERCENT OF FEDERAL POVERTY LEVEL. (a) A child is
1-16 eligible for health benefits coverage under the child health plan
1-17 subsidized in accordance with Section 62.153(a) if the child:
1-18 (1) is younger than 19 years of age;
1-19 (2) is not eligible for medical assistance under the
1-20 Medicaid program;
1-21 (3) is not covered by a health benefits plan offering
1-22 adequate benefits, as determined by the commission;
1-23 (4) has a family income that is less than or equal to
1-24 the income eligibility level established under Subsection (b); and
2-1 (5) satisfies any other eligibility standard imposed
2-2 under the child health plan program in accordance with 42 U.S.C.
2-3 Section 1397bb, as amended, and any other applicable law or
2-4 regulations.
2-5 (b) The commission shall establish income eligibility levels
2-6 for children eligible under this section consistent with Title XXI,
2-7 Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended,
2-8 and any other applicable law or regulations, and subject to the
2-9 availability of appropriated money, so that a child who is younger
2-10 than 19 years of age and whose net family income is at or below 200
2-11 percent of the federal poverty level is eligible for health
2-12 benefits coverage under the program under this section.
2-13 (c) For purposes of this chapter, a child who is eligible
2-14 for health benefits under this section is eligible as a member of
2-15 eligibility group A.
2-16 Sec. 62.1015. ELIGIBILITY GROUP B: NET FAMILY INCOME AT OR
2-17 BELOW 300 PERCENT OF FEDERAL POVERTY LEVEL. (a) A child is
2-18 eligible for health benefits coverage under the child health plan
2-19 subsidized in accordance with Section 62.153(b) if the child:
2-20 (1) meets the eligibility requirements of Sections
2-21 62.101(a)-(c);
2-22 (2) has a family income that is greater than the
2-23 income eligibility level established under Section 62.101 but less
2-24 than 300 percent of the federal poverty level; and
2-25 (3) satisfies any other eligibility standard imposed
2-26 by the commission by rule.
2-27 (b) For purposes of this chapter, a child who is eligible
3-1 for health benefits under this section is eligible as a member of
3-2 eligibility group B.
3-3 Sec. 62.1016. ELIGIBILITY GROUP C: BUY-IN COVERAGE; NET
3-4 FAMILY INCOME AT LEAST 300 PERCENT OF FEDERAL POVERTY LEVEL. (a) A
3-5 child is eligible for unsubsidized health benefits coverage under
3-6 the child health plan to be paid for in accordance with Section
3-7 62.153(c) if the child:
3-8 (1) meets the eligibility requirements of Sections
3-9 62.101(a)-(c);
3-10 (2) has a family income that is at least 300 percent
3-11 of the federal poverty level; and
3-12 (3) satisfies any other eligibility standard imposed
3-13 by the commission by rule.
3-14 (b) For purposes of this chapter, a child who is eligible
3-15 for health benefits under this section is eligible as a member of
3-16 eligibility group C.
3-17 Sec. 62.1017. ENROLLMENT LEVELS. [(c)] The commissioner
3-18 shall evaluate enrollment levels and program impact every six
3-19 months during the first 12 months of implementation and at least
3-20 annually thereafter and shall submit a finding of fact to the
3-21 Legislative Budget Board and the Governor's Office of Budget and
3-22 Planning as to the adequacy of funding for eligibility groups A and
3-23 B and the ability of the program to sustain enrollment at the
3-24 eligibility levels [level] established by Sections 62.101 and
3-25 62.1015 [Subsection (b)]. In the event that appropriated money is
3-26 insufficient to sustain enrollment at the authorized eligibility
3-27 level for eligibility group A or B, the commissioner shall, for
4-1 that eligibility group:
4-2 (1) suspend enrollment in the child health plan;
4-3 (2) establish a waiting list for applicants for
4-4 coverage; and
4-5 (3) establish a process for periodic or continued
4-6 enrollment of applicants in the child health plan program as the
4-7 availability of money allows.
4-8 SECTION 1.03. Section 62.105, Health and Safety Code, is
4-9 amended to read as follows:
4-10 Sec. 62.105. COVERAGE FOR QUALIFIED ALIENS. The commission
4-11 shall provide coverage under the state Medicaid program and as part
4-12 of eligibility group A or B of [under] the program established
4-13 under this chapter to a child who is a qualified alien, as that
4-14 term is defined by 8 U.S.C. Section 1641(b), if the federal
4-15 government authorizes the state to provide that coverage. The
4-16 commission shall comply with any prerequisite imposed under the
4-17 federal law to providing that coverage.
4-18 SECTION 1.04. Section 62.153, Health and Safety Code, is
4-19 amended to read as follows:
4-20 Sec. 62.153. COST SHARING. (a) To the extent permitted
4-21 under 42 U.S.C. Section 1397cc, as amended, and any other
4-22 applicable law or regulations, the commission shall require
4-23 enrollees in eligibility group A to share the cost of the child
4-24 health plan, including provisions requiring enrollees under the
4-25 child health plan to pay:
4-26 (1) a copayment for services provided under the plan;
4-27 (2) an enrollment fee; or
5-1 (3) a portion of the plan premium.
5-2 (b) The commission shall require enrollees in eligibility
5-3 group B to share the cost of the child health plan, including
5-4 provisions requiring enrollees under the child health plan to pay:
5-5 (1) a copayment for services provided under the plan;
5-6 (2) an enrollment fee; or
5-7 (3) a portion of the plan premium.
5-8 (c) Enrollees in eligibility group C shall pay a plan
5-9 premium in an amount actuarially determined to be sufficient for
5-10 the plan. The commission may require enrollees to pay:
5-11 (1) a copayment for services provided under the plan;
5-12 or
5-13 (2) an enrollment fee.
5-14 (d) If money allocated to the state by the federal
5-15 government under 42 U.S.C. Section 1397ee, as amended, is used to
5-16 provide coverage for enrollees in eligibility group B, those
5-17 enrollees may be required to share the cost of the child health
5-18 plan under Subsection (b) only to the extent permitted under 42
5-19 U.S.C. Section 1397cc, as amended, and any other applicable law or
5-20 regulations.
5-21 (e) Cost-sharing provisions adopted under this section shall
5-22 ensure that families with higher levels of income are required to
5-23 pay progressively higher percentages of the cost of the plan.
5-24 (f) The [(c) If cost-sharing provisions imposed under
5-25 Subsection (a) include requirements that enrollees pay a portion of
5-26 the plan premium, the] commission shall specify the manner in which
5-27 plan premiums are [the premium is] paid in accordance with this
6-1 section. The commission may require that the premium be paid to
6-2 the Texas Department of Health, the Texas Department of Human
6-3 Services, or the health plan provider.
6-4 SECTION 1.05. Chapter 62, Health and Safety Code, is amended
6-5 by adding Subchapter E to read as follows:
6-6 SUBCHAPTER E. ELIGIBILITY GROUPS B AND C
6-7 Sec. 62.201. ELIGIBILITY FOR FEDERAL FUNDS OR FEDERAL
6-8 MATCHING. (a) To the extent allowed by federal law, money
6-9 allocated to the state by the federal government under 42 U.S.C.
6-10 Section 1397ee, as amended, may be used to provide coverage for or
6-11 to pay administrative costs attributable to children in eligibility
6-12 group B.
6-13 (b) Money allocated to the state by the federal government
6-14 under 42 U.S.C. Section 1397ee, as amended, may not be used to
6-15 provide coverage for or to pay administrative costs attributable to
6-16 children in eligibility group C.
6-17 (c) To the extent that the expenditures are ineligible for
6-18 federal matching under federal law, expenditures made to provide
6-19 health benefits plan coverage for children in eligibility groups B
6-20 and C may not be included for the purpose of determining the state
6-21 children's health insurance expenditures, as that term is defined
6-22 by 42 U.S.C. Section 1397ee(d)(2)(B), as amended.
6-23 Sec. 62.202. CHILD HEALTH PLAN ELIGIBILITY GROUP B ACCOUNT.
6-24 (a) The child health plan eligibility group B account is an
6-25 account in the general revenue fund that may be used only to:
6-26 (1) provide state child health plan coverage for
6-27 children in eligibility group B under Section 62.1015; and
7-1 (2) pay administrative costs attributable to children
7-2 in eligibility groups B and C under Sections 62.1015 and 62.1016.
7-3 (b) The child health plan eligibility group B account
7-4 consists of money transferred from the Texas healthy kids fund
7-5 under former Chapter 109, money appropriated to the account, and
7-6 money appropriated to or deposited in the premium stabilization
7-7 revolving account established under Section 62.204.
7-8 Sec. 62.203. RESPONSIBILITY FOR PREMIUMS. (a) The parent,
7-9 managing conservator, or guardian of a child in eligibility group B
7-10 or eligibility group C, or another person sponsoring coverage for a
7-11 child in eligibility group B or C, is responsible for premiums for
7-12 coverage and for applicable enrollment fees or copayments as
7-13 determined by the commission.
7-14 (b) Except as provided by this subchapter, the commission
7-15 may terminate the coverage of a child in eligibility group B or C
7-16 for failure to pay a premium as required by Subsection (a).
7-17 Sec. 62.204. PREMIUM STABILIZATION REVOLVING ACCOUNT. (a)
7-18 The premium stabilization revolving account is an account within
7-19 the child health plan eligibility group B account.
7-20 (b) The premium stabilization revolving account is composed
7-21 of money contributed to the account under this subchapter and any
7-22 money appropriated to the account by the legislature.
7-23 Sec. 62.205. FEE; DEPOSIT TO ACCOUNT. (a) In addition to
7-24 payments required under Section 62.153, the commission shall charge
7-25 for each child in eligibility group B a reasonable premium
7-26 stabilization revolving account fee not to exceed $5 each month.
7-27 (b) The commission shall remit money collected under this
8-1 section to the comptroller, in accordance with rules adopted by the
8-2 comptroller, for deposit to the credit of the premium stabilization
8-3 revolving account.
8-4 Sec. 62.206. USE OF MONEY IN ACCOUNT. (a) Money in the
8-5 premium stabilization revolving account may be used by the
8-6 commission only to pay a premium for coverage provided through the
8-7 program for a child in eligibility group B for whom a premium is
8-8 not paid in accordance with Section 62.203(a).
8-9 (b) The commission shall determine the period for which
8-10 premiums may be paid from the fund and the circumstances under
8-11 which the premiums may be paid.
8-12 (c) The parent, managing conservator, or guardian of a child
8-13 for whom a premium is paid from the premium stabilization revolving
8-14 account, or another person sponsoring coverage for the child,
8-15 remains responsible for reimbursing the account for the premium
8-16 paid. The coverage for the child is subject to termination, in
8-17 accordance with criteria adopted by the commission, if the parent,
8-18 managing conservator, guardian, or sponsor fails to reimburse the
8-19 account as required by this subsection. The commission shall remit
8-20 money collected under this subsection to the comptroller for
8-21 deposit to the credit of the account.
8-22 ARTICLE 2. TEXAS HEALTHY KIDS CORPORATION
8-23 SECTION 2.01. Section 154.182(b), Family Code, is amended to
8-24 read as follows:
8-25 (b) Except as provided for by Subdivision (6), in
8-26 determining the manner in which health insurance for the child is
8-27 to be ordered, the court shall render its order in accordance with
9-1 the following priorities, unless a party shows good cause why a
9-2 particular order would not be in the best interest of the child:
9-3 (1) if health insurance is available for the child
9-4 through the obligor's employment or membership in a union, trade
9-5 association, or other organization, the court shall order the
9-6 obligor to include the child in the obligor's health insurance;
9-7 (2) if health insurance is not available for the child
9-8 through the obligor's employment but is available for the child
9-9 through the obligee's employment or membership in a union, trade
9-10 association, or other organization, the court may order the obligee
9-11 to provide health insurance for the child, and, in such event,
9-12 shall order the obligor to pay additional child support to be
9-13 withheld from earnings under Chapter 158 to the obligee for the
9-14 actual cost of the health insurance for the child;
9-15 (3) if health insurance is not available for the child
9-16 under Subdivision (1) or (2), the court shall order the obligor to
9-17 provide health insurance for the child if the court finds that
9-18 health insurance is available for the child from another source and
9-19 that the obligor is financially able to provide it;
9-20 (4) if health insurance is not available for the child
9-21 under Subdivision (1), (2), or (3), the court shall order the
9-22 obligor to apply for coverage through the state child health plan
9-23 [Texas Healthy Kids Corporation established] under Chapter 62
9-24 [109], Health and Safety Code;
9-25 (5) if health coverage is not available for the child
9-26 under Subdivision (1), (2), (3), or (4), the court shall order the
9-27 obligor to pay the obligee, in addition to any amount ordered under
10-1 the guidelines for child support, a reasonable amount each month as
10-2 medical support for the child to be withheld from earnings under
10-3 Chapter 158; or
10-4 (6) notwithstanding Subdivisions (1) through (3), an
10-5 obligor whose employer, union, trade association, or other
10-6 organization does not offer a child/children coverage option in
10-7 lieu of a spouse/child/children option of health insurance coverage
10-8 may elect to apply for coverage through the state child health plan
10-9 [Texas Healthy Kids Corporation]. An obligor required to pay
10-10 additional child support to an obligee for health insurance
10-11 coverage may elect to apply for coverage through the state child
10-12 health plan [Texas Healthy Kids Corporation] if the obligee's
10-13 employer, union, trade association, or other organization does not
10-14 offer a child/children coverage option in lieu of a
10-15 spouse/child/children option of health insurance coverage.
10-16 SECTION 2.02. Section 62.055, Health and Safety Code, is
10-17 amended to read as follows:
10-18 Sec. 62.055. CONTRACTS FOR IMPLEMENTATION OF CHILD HEALTH
10-19 PLAN. (a) It is the intent of the legislature that the commission
10-20 maximize the use of private resources in administering the child
10-21 health plan created under this chapter. In administering the child
10-22 health plan, the commission may contract with:
10-23 (1) a third party administrator to provide enrollment
10-24 and related services under the state child health plan; or
10-25 (2) another entity [, including the Texas Healthy Kids
10-26 Corporation under Subchapter F, Chapter 109,] to obtain health
10-27 benefit plan coverage for children who are eligible for coverage
11-1 under the state child health plan.
11-2 (b) [If the commission contracts with the Texas Healthy Kids
11-3 Corporation under Subchapter F, Chapter 109, to administer any part
11-4 of the child health plan created under this chapter, the
11-5 commission, prior to entering into any contract with the
11-6 corporation, shall conduct a readiness review of the corporation to
11-7 determine that the corporation and its contractors are able to
11-8 implement the child health plan on a statewide basis.
11-9 Notwithstanding the foregoing, if the board of directors of the
11-10 corporation, by a vote of the board, determines that the
11-11 corporation is unable to implement the child health plan on a
11-12 statewide basis, the commission may not contract with the
11-13 corporation under this section.]
11-14 [(c) The commission's review of the corporation and its
11-15 contractors under Subsection (b) shall be based at a minimum on the
11-16 following criteria:]
11-17 [(1) adequate and appropriate staffing, including
11-18 contracts with third parties;]
11-19 [(2) adequate and properly documented policies and
11-20 procedures;]
11-21 [(3) fiscal soundness;]
11-22 [(4) compliance with all applicable federal and state
11-23 standards, rules, and regulations;]
11-24 [(5) necessary accommodations for the needs of
11-25 families with special needs children;]
11-26 [(6) necessary partnerships with other programs
11-27 addressing children's health care needs; and]
12-1 [(7) adequate information systems, electronic
12-2 interfaces, and business processes.]
12-3 [(d)] A third party administrator or other entity may
12-4 perform tasks under the contract that would otherwise be performed
12-5 by the Texas Department of Health or Texas Department of Human
12-6 Services under this chapter.
12-7 (c) [(e)] The commission shall:
12-8 (1) retain all policymaking authority over the state
12-9 child health plan;
12-10 (2) procure all contracts with a third party
12-11 administrator or other entity through a competitive procurement
12-12 process in compliance with all applicable federal and state laws or
12-13 regulations; and
12-14 (3) ensure that all contracts with child health plan
12-15 providers under Section 62.155 are procured through a competitive
12-16 procurement process in compliance with all applicable federal and
12-17 state laws or regulations.
12-18 SECTION 2.03. Section 62.056(a), Health and Safety Code, is
12-19 amended to read as follows:
12-20 (a) The commission shall conduct a community outreach and
12-21 education campaign to provide information relating to the
12-22 availability of health benefits for children under this chapter.
12-23 The commission shall conduct the campaign in a manner that promotes
12-24 enrollment in, and minimizes duplication of effort among, all state
12-25 administered child health programs [and, subject to the approval of
12-26 the board of the Texas Healthy Kids Corporation, the program
12-27 offered under Chapter 109].
13-1 SECTION 2.04. Section 62.103(b), Health and Safety Code, is
13-2 amended to read as follows:
13-3 (b) The form and procedures must be coordinated with forms
13-4 and procedures under the Medicaid program [and those used by the
13-5 Texas Healthy Kids Corporation] to ensure that, to the extent
13-6 possible, there is a single consolidated application to seek
13-7 assistance under this chapter or the Medicaid program [or from the
13-8 corporation].
13-9 SECTION 2.05. Section 62.154(d), Health and Safety Code, is
13-10 amended to read as follows:
13-11 (d) The waiting period required by Subsection (a) must:
13-12 (1) extend for a period of 90 days after the last date
13-13 on which the applicant was covered under a health benefits plan;
13-14 and
13-15 (2) apply to a child who was covered by a health
13-16 benefits plan at any time during the 90 days before the date of
13-17 application for coverage under the child health plan, other than a
13-18 child who was covered under a health benefits plan provided under
13-19 former Chapter 109.
13-20 SECTION 2.06. Section 62.155(c), Health and Safety Code, is
13-21 amended to read as follows:
13-22 (c) In selecting a health plan provider, the commission:
13-23 (1) may give preference to a person who provides
13-24 similar coverage under the Medicaid program [or through the Texas
13-25 Healthy Kids Corporation]; and
13-26 (2) shall provide for a choice of at least two health
13-27 plan providers in each metropolitan area.
14-1 SECTION 2.07. Chapter 109, Health and Safety Code, is
14-2 repealed.
14-3 SECTION 2.08. Section 171.063(h), Tax Code, is repealed.
14-4 ARTICLE 3. EFFECTIVE DATE; TRANSITION
14-5 SECTION 3.01. (a) Not later than the 90th day after the
14-6 effective date of this Act, the Health and Human Services
14-7 Commission shall submit for approval a plan amendment relating to
14-8 the state child health plan under 42 U.S.C. Section 1397ff, as
14-9 amended, as necessary to comply with the change in law made by this
14-10 Act.
14-11 (b) The Health and Human Services Commission and the Texas
14-12 Healthy Kids Corporation shall examine the rolls of those children
14-13 provided health benefits by the corporation. Effective on the date
14-14 that amendments to the state child health plan necessary to
14-15 implement the change in law made by this Act become effective, the
14-16 commission and the corporation shall take the actions necessary to
14-17 transfer those children who are eligible for the state child health
14-18 plan, as amended by this Act, to the plan. The commission shall
14-19 waive any waiting period required by Section 62.154(a), Health and
14-20 Safety Code, for those children transferred to the state child
14-21 health plan under this Act.
14-22 (c) Effective on the date that the amendments to the state
14-23 child health plan necessary to implement the change in law made by
14-24 Article 1 of this Act become effective, the comptroller shall
14-25 transfer all money in the Texas healthy kids fund under Section
14-26 109.002, Health and Safety Code, to the state child health plan
14-27 eligibility group B account under Section 62.202, Health and Safety
15-1 Code, as added by this Act. If the amendments to the state child
15-2 health plan do not become effective before September 1, 2003, the
15-3 comptroller shall transfer the money in the Texas healthy kids fund
15-4 to the general revenue fund on that date.
15-5 SECTION 3.02. (a) Notwithstanding the change in law made by
15-6 this Act, the Texas Healthy Kids Corporation may continue to offer
15-7 the program provided by the corporation until the earlier of:
15-8 (1) the date the amendments to the state child health
15-9 plan necessary to implement the change in law made by Article 1 of
15-10 this Act become effective; or
15-11 (2) September 1, 2003.
15-12 (b) On the date specified by Subsection (a) of this section,
15-13 the program provided by the Texas Healthy Kids Corporation is
15-14 terminated. Not later than the 30th day after that date, the board
15-15 of directors of the corporation shall begin the steps necessary to
15-16 dissolve the corporation and wind up its affairs.
15-17 SECTION 3.03. Section 2.08 of this Act takes effect January
15-18 1, 2002, and applies only to a tax report originally due on or
15-19 after that date.
15-20 SECTION 3.04. Except as provided in Section 3.03, this Act
15-21 takes effect immediately if it receives a vote of two-thirds of all
15-22 the members elected to each house, as provided by Section 39,
15-23 Article III, Texas Constitution. If this Act does not receive the
15-24 vote necessary for immediate effect, this Act takes effect
15-25 September 1, 2001.