77R11116 CLG-D
By Isett H.B. No. 3038
Substitute the following for H.B. No. 3038:
By Delisi C.S.H.B. No. 3038
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the employment of Medicaid recipients and to the
1-3 enrollment of Medicaid recipients and state child health plan
1-4 enrollees in certain group health benefit plans.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subchapter B, Chapter 62, Health and Safety Code,
1-7 is amended by adding Section 62.059 to read as follows:
1-8 Sec. 62.059. HEALTH INSURANCE PREMIUM PAYMENT REIMBURSEMENT
1-9 PROGRAM FOR CHILDREN ELIGIBLE FOR CHILD HEALTH PLAN. (a) In this
1-10 section, "group health benefit plan" has the meaning assigned by
1-11 Article 21.52K, Insurance Code.
1-12 (b) Under the direction of the commission, the Texas
1-13 Department of Health shall identify children, otherwise eligible to
1-14 enroll in the state child health plan under this chapter, who are
1-15 eligible to enroll in a group health benefit plan.
1-16 (c) For a child identified under Subsection (b), the
1-17 department shall determine whether it is cost-effective to enroll
1-18 the child in the group health benefit plan under this section.
1-19 (d) If the department determines that it is cost-effective
1-20 to enroll the child in the group health benefit plan, the
1-21 department shall:
1-22 (1) require the child to apply to enroll in the group
1-23 health benefit plan as a condition for eligibility under this
1-24 chapter; and
2-1 (2) provide written notice to the issuer of the group
2-2 health benefit plan in accordance with Article 21.52K, Insurance
2-3 Code.
2-4 (e) The department shall provide for payment of the
2-5 employee's share of required premiums for coverage of a child
2-6 enrolled in the group health benefit plan.
2-7 (f) In addition to any amount paid under Subsection (e), the
2-8 department may provide for the payment of a group health benefit
2-9 plan premium for the child's parent or for an individual who is a
2-10 member of the child's family if:
2-11 (1) the child is not eligible to be enrolled in the
2-12 group health benefit plan unless the other individual is also
2-13 enrolled in the plan; and
2-14 (2) the department determines it to be cost-effective.
2-15 (g) The department may not provide for the payment of any
2-16 deductible, copayment, coinsurance, or other cost-sharing
2-17 obligation for the child or another individual enrolled in a group
2-18 health benefit plan under Subsection (f).
2-19 (h) Enrollment of a child in a group health benefit plan
2-20 under this chapter does not affect the child's eligibility for
2-21 benefits under this chapter, except that the program is the payor
2-22 of last resort for those benefits.
2-23 (i) The department may consolidate or coordinate the
2-24 administration of the program provided under this section with a
2-25 similar program provided under Section 32.0422, Human Resources
2-26 Code, for individuals eligible for medical assistance under the
2-27 state Medicaid program.
3-1 SECTION 2. Subchapter B, Chapter 32, Human Resources Code, is
3-2 amended by adding Section 32.0422 to read as follows:
3-3 Sec. 32.0422. HEALTH INSURANCE PREMIUM PAYMENT REIMBURSEMENT
3-4 PROGRAM FOR MEDICAL ASSISTANCE RECIPIENTS. (a) In this section:
3-5 (1) "Department" means the Texas Department of Health.
3-6 (2) "Group health benefit plan" has the meaning
3-7 assigned by Article 21.52K, Insurance Code.
3-8 (b) The department shall identify individuals, otherwise
3-9 entitled to medical assistance, who are eligible to enroll in a
3-10 group health benefit plan. The department must include individuals
3-11 eligible for or receiving health care services under a Medicaid
3-12 managed care delivery system.
3-13 (c) The department shall require an individual requesting
3-14 medical assistance to provide information as necessary relating to
3-15 the availability of a group health benefit plan to the individual
3-16 through an employer of the individual or an employer of the
3-17 individual's spouse or parent.
3-18 (d) For an individual identified under Subsection (b), the
3-19 department shall determine whether it is cost-effective to enroll
3-20 the individual in the group health benefit plan under this section.
3-21 (e) If the department determines that it is cost-effective
3-22 to enroll the individual in the group health benefit plan, the
3-23 department shall:
3-24 (1) require the individual to apply to enroll in the
3-25 group health benefit plan as a condition for eligibility under the
3-26 medical assistance program; and
3-27 (2) provide written notice to the issuer of the group
4-1 health benefit plan in accordance with Article 21.52K, Insurance
4-2 Code.
4-3 (f) The department shall provide for payment of:
4-4 (1) the employee's share of required premiums for
4-5 coverage of an individual enrolled in the group health benefit
4-6 plan; and
4-7 (2) any deductible, copayment, coinsurance, or other
4-8 cost-sharing obligation imposed on the enrolled individual for an
4-9 item or service otherwise covered under the medical assistance
4-10 program.
4-11 (g) A payment made by the department under Subsection (f) is
4-12 considered to be a payment for medical assistance.
4-13 (h) A payment of a premium for an individual who is a member
4-14 of the family of an individual enrolled in a group health benefit
4-15 plan under this section and who is not eligible for medical
4-16 assistance is considered to be a payment for medical assistance for
4-17 an eligible individual if:
4-18 (1) enrollment of the family members who are eligible
4-19 for medical assistance is not possible under the plan without also
4-20 enrolling members who are not eligible; and
4-21 (2) the department determines it to be cost-effective.
4-22 (i) A payment of any deductible, copayment, coinsurance, or
4-23 other cost-sharing obligation of a family member who is enrolled in
4-24 a group health benefit plan in accordance with Subsection (h) and
4-25 who is not eligible for medical assistance:
4-26 (1) may not be paid under this chapter; and
4-27 (2) is not considered to be a payment for medical
5-1 assistance for an eligible individual.
5-2 (j) The department shall treat coverage under the group
5-3 health benefit plan as a third party liability to the program.
5-4 Enrollment of an individual in a group health benefit plan under
5-5 this section does not affect the individual's eligibility for
5-6 medical assistance benefits, except that the state is entitled to
5-7 payment under Sections 32.033 and 32.038.
5-8 (k) The department may not require or permit an individual
5-9 who is enrolled in a group health benefit plan under this section
5-10 to participate in the Medicaid managed care program under Chapter
5-11 533, Government Code, or a Medicaid managed care demonstration
5-12 project under Section 32.041.
5-13 (l) The Texas Department of Human Services shall provide
5-14 information and otherwise cooperate with the department as
5-15 necessary to ensure the enrollment of eligible individuals in the
5-16 group health benefit plan under this section.
5-17 (m) The department may consolidate or coordinate the
5-18 administration of the program provided under this section with a
5-19 similar program provided under Section 62.059, Health and Safety
5-20 Code, for children eligible for the state child health plan.
5-21 (n) The department shall adopt rules as necessary to
5-22 implement this section.
5-23 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
5-24 amended by adding Article 21.52K to read as follows:
5-25 Art. 21.52K. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND
5-26 CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN
5-27 Sec. 1. DEFINITION OF GROUP HEALTH BENEFIT PLAN. (a) In
6-1 this article, "group health benefit plan" means a plan that
6-2 provides benefits for medical or surgical expenses incurred as a
6-3 result of a health condition, accident, or sickness, including a
6-4 group, blanket, or franchise insurance policy or insurance
6-5 agreement, a group hospital service contract, or a group evidence
6-6 of coverage or similar group coverage document that is offered by:
6-7 (1) an insurance company;
6-8 (2) a group hospital service corporation operating
6-9 under Chapter 20 of this code;
6-10 (3) a fraternal benefit society operating under
6-11 Chapter 10 of this code;
6-12 (4) a stipulated premium insurance company operating
6-13 under Chapter 22 of this code;
6-14 (5) a reciprocal exchange operating under Chapter 19
6-15 of this code;
6-16 (6) a health maintenance organization operating under
6-17 the Texas Health Maintenance Organization Act (Chapter 20A,
6-18 Vernon's Texas Insurance Code);
6-19 (7) a multiple employer welfare arrangement that holds
6-20 a certificate of authority under Article 3.95-2 of this code; or
6-21 (8) an approved nonprofit health corporation that
6-22 holds a certificate of authority under Article 21.52F of this code.
6-23 (b) The term "group health benefit plan" includes:
6-24 (1) a small employer health benefit plan written under
6-25 Chapter 26 of this code; and
6-26 (2) a plan provided under the Texas Employees Uniform
6-27 Group Insurance Benefits Act (Article 3.50-2, Vernon's Texas
7-1 Insurance Code), the Texas State College and University Employees
7-2 Uniform Insurance Benefits Act (Article 3.50-3, Vernon's Texas
7-3 Insurance Code), the Texas Public School Employees Group Insurance
7-4 Act (Article 3.50-4, Vernon's Texas Insurance Code), or a successor
7-5 of any of those plans.
7-6 Sec. 2. ENROLLMENT REQUIRED. (a) The issuer of a group
7-7 health benefit plan, on receipt of written notice from the Texas
7-8 Department of Health or a designee of the Texas Department of
7-9 Health that states that an individual who is otherwise eligible for
7-10 enrollment in the plan is a recipient of medical assistance under
7-11 the state Medicaid program and is a participant in the health
7-12 insurance premium payment reimbursement program for medical
7-13 assistance recipients under Section 32.044, Human Resources Code,
7-14 shall permit the individual to enroll in the plan without regard to
7-15 any enrollment period restriction.
7-16 (b) The issuer of a group health benefit plan, on receipt of
7-17 written notice from the Texas Department of Health or a designee of
7-18 the Texas Department of Health that states that a child who is
7-19 otherwise eligible for enrollment in the plan is enrolled in the
7-20 state child health plan under Chapter 62, Health and Safety Code,
7-21 and is a participant in the health insurance premium payment
7-22 reimbursement program under Section 62.059, Health and Safety Code,
7-23 provided for children eligible for the state child health plan
7-24 shall permit the child to enroll in the group health benefit plan
7-25 without regard to any enrollment period restriction.
7-26 (c) If an individual described by Subsection (a) or (b) of
7-27 this section is not eligible to enroll in the plan unless a family
8-1 member of the individual is also enrolled in the plan, the issuer,
8-2 on receipt of the written notice under Subsection (a) or (b) of
8-3 this section, shall enroll both the individual and the family
8-4 member in the plan.
8-5 (d) Unless enrollment occurs during an established
8-6 enrollment period, enrollment under this article takes effect on
8-7 the first day of the calendar month that begins at least 30 days
8-8 after the date written notice is received by the issuer under
8-9 Subsection (a) or (b) of this section.
8-10 (e) Notwithstanding any other requirement of the group
8-11 health benefit plan, the issuer of the plan shall permit an
8-12 individual who is enrolled in a group health benefit plan under
8-13 Subsection (a) of this section, and any family member of the
8-14 individual enrolled under Subsection (c) of this section, to
8-15 terminate enrollment in the plan not later than the 60th day after
8-16 the date on which the individual provides satisfactory proof to the
8-17 issuer that the individual is no longer:
8-18 (1) a recipient of medical assistance under the state
8-19 Medicaid program; or
8-20 (2) a participant in the health insurance premium
8-21 payment program for medical assistance recipients under Section
8-22 32.0422, Human Resources Code.
8-23 (f) Notwithstanding any other requirement of the group
8-24 health benefit plan, the issuer of the plan shall permit an
8-25 individual who is enrolled in a group health benefit plan under
8-26 Subsection (b) of this section, and any family member of the
8-27 individual enrolled under Subsection (c) of this section, to
9-1 terminate enrollment in the plan not later than the 60th day after
9-2 the date on which the individual provides satisfactory proof to the
9-3 issuer that the child is no longer a participant in the health
9-4 insurance premium payment program under Section 62.059, Health and
9-5 Safety Code, provided for children eligible for the state child
9-6 health plan.
9-7 SECTION 4. Section 301.104, Labor Code, is amended to read as
9-8 follows:
9-9 Sec. 301.104. ELIGIBILITY. A person is eligible for the
9-10 refund for wages paid or incurred by the person, during each
9-11 calendar year for which the refund is claimed, only if:
9-12 (1) the wages paid or incurred by the person are for
9-13 services of an employee who is:
9-14 (A) a resident of this state; and
9-15 (B) a recipient of:
9-16 (i) financial assistance and services in
9-17 accordance with Chapter 31, Human Resources Code; or
9-18 (ii) medical assistance in accordance with
9-19 Chapter 32, Human Resources Code;
9-20 (2) the person satisfies the certification
9-21 requirements under Section 301.105; and
9-22 (3) the person provides and pays for the benefit of
9-23 the employee a part of the cost of coverage under:
9-24 (A) a health plan provided by a health
9-25 maintenance organization established under the Texas Health
9-26 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
9-27 Code);
10-1 (B) a health benefit plan approved by the
10-2 commissioner of insurance; [or]
10-3 (C) a self-funded or self-insured employee
10-4 welfare benefit plan that provides health benefits and is
10-5 established in accordance with the Employee Retirement Income
10-6 Security Act of 1974 (29 U.S.C. 1001 et seq.); or
10-7 (D) a medical savings account authorized under
10-8 the Health Insurance Portability and Accountability Act of 1996 (26
10-9 U.S.C. Section 220).
10-10 SECTION 5. (a) The Texas Department of Health shall study:
10-11 (1) various options for increasing enrollment in a
10-12 group health benefit plan under Section 32.0422, Human Resources
10-13 Code, as added by this Act; and
10-14 (2) the feasibility of implementing an income-based
10-15 sliding scale requiring payment of a portion of the plan premium
10-16 from a person who:
10-17 (A) is receiving transitional medical assistance
10-18 under Section 32.0255, Human Resources Code;
10-19 (B) is employed; and
10-20 (C) is eligible for and enrolled in a group
10-21 health benefit plan described by Subdivision (1) of this section.
10-22 (b) Not later than December 1, 2002, the Texas Department of
10-23 Health shall report its conclusions and recommendations regarding
10-24 the study conducted under Subsection (a) of this section to the
10-25 governor, lieutenant governor, speaker of the house of
10-26 representatives, and presiding officer of each standing committee
10-27 of the senate and house of representatives having jurisdiction over
11-1 health and human services issues.
11-2 SECTION 6. A person may claim a refund under Section 301.104,
11-3 Labor Code, as amended by this Act, only for wages paid or incurred
11-4 on or after the effective date of this Act.
11-5 SECTION 7. If before implementing any provision of this Act a
11-6 state agency determines that a waiver or authorization from a
11-7 federal agency is necessary for implementation, the state agency
11-8 shall request the waiver or authorization and may delay
11-9 implementing that provision until the waiver or authorization is
11-10 granted.
11-11 SECTION 8. (a) The Health and Human Services Commission
11-12 shall, not later than September 15, 2001, submit for approval a
11-13 plan amendment relating to the state child health plan under 42
11-14 U.S.C. Section 1397ff, as amended, as necessary to comply with the
11-15 change in law made by this Act.
11-16 (b) The Health and Human Services Commission may delay,
11-17 until approval of the amended state child health plan,
11-18 implementation of the health insurance premium payment
11-19 reimbursement program under Section 62.059, Health and Safety Code,
11-20 as added by this Act.
11-21 SECTION 9. (a) Except as provided by Subsection (b) of this
11-22 section, this Act takes effect September 1, 2001.
11-23 (b) The changes in law made by Sections 1, 2, and 3 of this
11-24 Act take effect August 31, 2001, and apply only to a group health
11-25 benefit plan that is delivered, issued for delivery, or renewed on
11-26 or after that date. A group health benefit plan that is delivered,
11-27 issued for delivery, or renewed before August 31, 2001, is
12-1 governed by the law as it existed immediately before that date, and
12-2 that law is continued in effect for that purpose.