By Isett H.B. No. 3038
77R7050 CLG-F
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:
2-5 (1) required premiums for the group health benefit
2-6 plan; and
2-7 (2) any deductible, copayment, coinsurance, or other
2-8 cost-sharing obligation imposed on the enrolled child for an item
2-9 or service otherwise covered under the state child health plan
2-10 under this chapter.
2-11 (f) In addition to any amount paid under Subsection (e), the
2-12 department may provide for the payment of a group health benefit
2-13 plan premium for the child's parent or another individual if:
2-14 (1) the child is a dependent of the other individual
2-15 and is not eligible to be enrolled in the group health benefit plan
2-16 unless the other individual is also enrolled in the plan; and
2-17 (2) the department determines it to be cost-effective.
2-18 (g) The department may not provide for the payment of any
2-19 deductible, copayment, coinsurance, or other cost-sharing
2-20 obligation of an individual enrolled in a group health benefit plan
2-21 under Subsection (f).
2-22 (h) Enrollment of a child in a group health benefit plan
2-23 under this chapter does not affect the child's eligibility for
2-24 benefits under this chapter, except that the program is the payor
2-25 of last resort for those benefits.
2-26 (i) The department may consolidate or coordinate the
2-27 administration of the program provided under this section with a
3-1 similar program provided under Section 32.0422, Human Resources
3-2 Code, for individuals eligible for medical assistance under the
3-3 state Medicaid program.
3-4 SECTION 2. Subchapter B, Chapter 32, Human Resources Code, is
3-5 amended by adding Section 32.0422 to read as follows:
3-6 Sec. 32.0422. HEALTH INSURANCE PREMIUM PAYMENT REIMBURSEMENT
3-7 PROGRAM FOR MEDICAL ASSISTANCE RECIPIENTS. (a) In this section:
3-8 (1) "Department" means the Texas Department of Health.
3-9 (2) "Group health benefit plan" has the meaning
3-10 assigned by Article 21.52K, Insurance Code.
3-11 (b) The department shall identify individuals, otherwise
3-12 entitled to medical assistance, who are eligible to enroll in a
3-13 group health benefit plan. The department must include individuals
3-14 eligible for or receiving health care services under a Medicaid
3-15 managed care delivery system.
3-16 (c) The department shall require an individual requesting
3-17 medical assistance to provide information as necessary relating to
3-18 the availability of a group health benefit plan to the individual
3-19 through an employer of the individual or an employer of the
3-20 individual's spouse or parent.
3-21 (d) For an individual identified under Subsection (b), the
3-22 department shall determine whether it is cost-effective to enroll
3-23 the individual in the group health benefit plan under this section.
3-24 (e) If the department determines that it is cost-effective
3-25 to enroll the individual in the group health benefit plan, the
3-26 department shall:
3-27 (1) require the individual to apply to enroll in the
4-1 group health benefit plan as a condition for eligibility under the
4-2 medical assistance program; and
4-3 (2) provide written notice to the issuer of the group
4-4 health benefit plan in accordance with Article 21.52K, Insurance
4-5 Code.
4-6 (f) The department shall provide for payment of:
4-7 (1) required premiums for the group health benefit
4-8 plan; and
4-9 (2) any deductible, copayment, coinsurance, or other
4-10 cost-sharing obligation imposed on the enrolled individual for an
4-11 item or service otherwise covered under the medical assistance
4-12 program.
4-13 (g) A payment made by the department under Subsection (f) is
4-14 considered to be a payment for medical assistance.
4-15 (h) A payment of a premium for an individual who is a member
4-16 of the family of an individual enrolled in a group health benefit
4-17 plan under this section and who is not eligible for medical
4-18 assistance is considered to be a payment for medical assistance for
4-19 an eligible individual if:
4-20 (1) enrollment of the family members who are eligible
4-21 for medical assistance is not possible under the plan without also
4-22 enrolling members who are not eligible; and
4-23 (2) the department determines it to be cost-effective.
4-24 (i) A payment of any deductible, copayment, coinsurance, or
4-25 other cost-sharing obligation of a family member who is enrolled in
4-26 a group health benefit plan in accordance with Subsection (h) and
4-27 who is not eligible for medical assistance:
5-1 (1) may not be paid under this chapter; and
5-2 (2) is not considered to be a payment for medical
5-3 assistance for an eligible individual.
5-4 (j) The department shall treat coverage under the group
5-5 health benefit plan as a third party liability to the program.
5-6 Enrollment of an individual in a group health benefit plan under
5-7 this section does not affect the individual's eligibility for
5-8 medical assistance benefits, except that the state is entitled to
5-9 payment under Sections 32.033 and 32.038.
5-10 (k) The department may not require or permit an individual
5-11 who is enrolled in a group health benefit plan under this section
5-12 to participate in the Medicaid managed care program under Chapter
5-13 533, Government Code, or a Medicaid managed care demonstration
5-14 project under Section 32.041.
5-15 (l) The Texas Department of Human Services shall provide
5-16 information and otherwise cooperate with the department as
5-17 necessary to ensure the enrollment of eligible individuals in the
5-18 group health benefit plan under this section.
5-19 (m) The department may consolidate or coordinate the
5-20 administration of the program provided under this section with a
5-21 similar program provided under Section 62.059, Health and Safety
5-22 Code, for children eligible for the state child health plan.
5-23 (n) The department shall adopt rules as necessary to
5-24 implement this section.
5-25 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
5-26 amended by adding Article 21.52K to read as follows:
5-27 Art. 21.52K. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND
6-1 CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN
6-2 Sec. 1. DEFINITION OF GROUP HEALTH BENEFIT PLAN. (a) In
6-3 this article, "group health benefit plan" means a plan that
6-4 provides benefits for medical or surgical expenses incurred as a
6-5 result of a health condition, accident, or sickness, including a
6-6 group, blanket, or franchise insurance policy or insurance
6-7 agreement, a group hospital service contract, or a group evidence
6-8 of coverage or similar group coverage document that is offered by:
6-9 (1) an insurance company;
6-10 (2) a group hospital service corporation operating
6-11 under Chapter 20 of this code;
6-12 (3) a fraternal benefit society operating under
6-13 Chapter 10 of this code;
6-14 (4) a stipulated premium insurance company operating
6-15 under Chapter 22 of this code;
6-16 (5) a reciprocal exchange operating under Chapter 19
6-17 of this code;
6-18 (6) a health maintenance organization operating under
6-19 the Texas Health Maintenance Organization Act (Chapter 20A,
6-20 Vernon's Texas Insurance Code);
6-21 (7) a multiple employer welfare arrangement that holds
6-22 a certificate of authority under Article 3.95-2 of this code; or
6-23 (8) an approved nonprofit health corporation that
6-24 holds a certificate of authority under Article 21.52F of this code.
6-25 (b) The term "group health benefit plan" includes:
6-26 (1) a small employer health benefit plan written under
6-27 Chapter 26 of this code; and
7-1 (2) a plan provided under the Texas Employees Uniform
7-2 Group Insurance Benefits Act (Article 3.50-2, Vernon's Texas
7-3 Insurance Code), the Texas State College and University Employees
7-4 Uniform Insurance Benefits Act (Article 3.50-3, Vernon's Texas
7-5 Insurance Code), the Texas Public School Employees Group Insurance
7-6 Act (Article 3.50-4, Vernon's Texas Insurance Code), or a successor
7-7 of any of those plans.
7-8 Sec. 2. ENROLLMENT REQUIRED. (a) The issuer of a group
7-9 health benefit plan, on receipt of written notice from the Texas
7-10 Department of Health or a designee of the Texas Department of
7-11 Health that states that an individual who is otherwise eligible for
7-12 enrollment in the plan is a recipient of medical assistance under
7-13 the state Medicaid program and is a participant in the health
7-14 insurance premium payment reimbursement program for medical
7-15 assistance recipients under Section 32.044, Human Resources Code,
7-16 shall permit the individual to enroll in the plan without regard to
7-17 any enrollment period restriction.
7-18 (b) The issuer of a group health benefit plan, on receipt of
7-19 written notice from the Texas Department of Health or a designee of
7-20 the Texas Department of Health that states that a child who is
7-21 otherwise eligible for enrollment in the plan is enrolled in the
7-22 state child health plan under Chapter 62, Health and Safety Code,
7-23 and is a participant in the health insurance premium payment
7-24 reimbursement program under Section 62.059, Health and Safety Code,
7-25 provided for children eligible for the state child health plan
7-26 shall permit the child to enroll in the group health benefit plan
7-27 without regard to any enrollment period restriction.
8-1 (c) If the child described by Subsection (b) of this section
8-2 is a dependent of another individual who is eligible to enroll in
8-3 the group health benefit plan and the child is not eligible to
8-4 enroll in the plan unless the other individual is also enrolled in
8-5 the plan, the issuer, on receipt of the written notice under
8-6 Subsection (b) of this section, shall enroll both the individual
8-7 and the dependent child in the plan.
8-8 (d) Unless enrollment occurs during an established
8-9 enrollment period, enrollment under this article takes effect on
8-10 the first day of the calendar month that begins at least 30 days
8-11 after the date written notice is received by the issuer under
8-12 Subsection (a) or (b) of this section.
8-13 (e) Notwithstanding any other requirement of the group
8-14 health benefit plan, the issuer of the plan shall permit an
8-15 individual who is enrolled in a group health benefit plan under
8-16 Subsection (a) of this section to terminate enrollment in the plan
8-17 if the individual provides satisfactory proof that the individual
8-18 is no longer:
8-19 (1) a recipient of medical assistance under the state
8-20 Medicaid program; or
8-21 (2) a participant in the health insurance premium
8-22 payment program for medical assistance recipients under Section
8-23 32.0422, Human Resources Code.
8-24 (f) Notwithstanding any other requirement of the group
8-25 health benefit plan, the issuer of the plan shall permit an
8-26 individual who is enrolled in a group health benefit plan under
8-27 Subsection (b) or (c) of this section to terminate enrollment in
9-1 the plan if the individual provides satisfactory proof that the
9-2 child is no longer a participant in the health insurance premium
9-3 payment program under Section 62.059, Health and Safety Code,
9-4 provided for children eligible for the state child health plan.
9-5 SECTION 4. Section 301.104, Labor Code, is amended to read as
9-6 follows:
9-7 Sec. 301.104. ELIGIBILITY. A person is eligible for the
9-8 refund for wages paid or incurred by the person, during each
9-9 calendar year for which the refund is claimed, only if:
9-10 (1) the wages paid or incurred by the person are for
9-11 services of an employee who is:
9-12 (A) a resident of this state; and
9-13 (B) a recipient of:
9-14 (i) financial assistance and services in
9-15 accordance with Chapter 31, Human Resources Code; or
9-16 (ii) medical assistance in accordance with
9-17 Chapter 32, Human Resources Code;
9-18 (2) the person satisfies the certification
9-19 requirements under Section 301.105; and
9-20 (3) the person provides and pays for the benefit of
9-21 the employee a part of the cost of coverage under:
9-22 (A) a health plan provided by a health
9-23 maintenance organization established under the Texas Health
9-24 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
9-25 Code);
9-26 (B) a health benefit plan approved by the
9-27 commissioner of insurance; [or]
10-1 (C) a self-funded or self-insured employee
10-2 welfare benefit plan that provides health benefits and is
10-3 established in accordance with the Employee Retirement Income
10-4 Security Act of 1974 (29 U.S.C. 1001 et seq.); or
10-5 (D) a medical savings account authorized under
10-6 the Health Insurance Portability and Accountability Act of 1996 (26
10-7 U.S.C. Section 220).
10-8 SECTION 5. (a) The Texas Department of Health shall study:
10-9 (1) various options for increasing enrollment in a
10-10 group health benefit plan under Section 32.0422, Human Resources
10-11 Code, as added by this Act; and
10-12 (2) the feasibility of implementing an income-based
10-13 sliding scale requiring payment of a portion of the plan premium
10-14 from a person who:
10-15 (A) is receiving transitional medical assistance
10-16 under Section 32.0255, Human Resources Code;
10-17 (B) is employed; and
10-18 (C) is eligible for and enrolled in a group
10-19 health benefit plan described by Subdivision (1) of this section.
10-20 (b) Not later than December 1, 2002, the Texas Department of
10-21 Health shall report its conclusions and recommendations regarding
10-22 the study conducted under Subsection (a) of this section to the
10-23 governor, lieutenant governor, speaker of the house of
10-24 representatives, and presiding officer of each standing committee
10-25 of the senate and house of representatives having jurisdiction over
10-26 health and human services issues.
10-27 SECTION 6. A person may claim a refund under Section 301.104,
11-1 Labor Code, as amended by this Act, only for wages paid or incurred
11-2 on or after the effective date of this Act.
11-3 SECTION 7. If before implementing any provision of this Act a
11-4 state agency determines that a waiver or authorization from a
11-5 federal agency is necessary for implementation, the state agency
11-6 shall request the waiver or authorization and may delay
11-7 implementing that provision until the waiver or authorization is
11-8 granted.
11-9 SECTION 8. (a) The Health and Human Services Commission
11-10 shall, not later than September 15, 2001, submit for approval a
11-11 plan amendment relating to the state child health plan under 42
11-12 U.S.C. Section 1397ff, as amended, as necessary to comply with the
11-13 change in law made by this Act.
11-14 (b) The Health and Human Services Commission may delay,
11-15 until approval of the amended state child health plan,
11-16 implementation of the health insurance premium payment
11-17 reimbursement program under Section 62.059, Health and Safety Code,
11-18 as added by this Act.
11-19 SECTION 9. (a) Except as provided by Subsection (b) of this
11-20 section, this Act takes effect September 1, 2001.
11-21 (b) The changes in law made by Sections 1, 2, and 3 of this
11-22 Act take effect August 31, 2001, and apply only to a group health
11-23 benefit plan that is delivered, issued for delivery, or renewed on
11-24 or after that date. A group health benefit plan that is delivered,
11-25 issued for delivery, or renewed before August 31, 2001, is
11-26 governed by the law as it existed immediately before that date, and
11-27 that law is continued in effect for that purpose.