1-1 By: Isett (Senate Sponsor - Nelson) H.B. No. 3038
1-2 (In the Senate - Received from the House May 11, 2001;
1-3 May 11, 2001, read first time and referred to Committee on Health
1-4 and Human Services; May 11, 2001, reported favorably by the
1-5 following vote: Yeas 7, Nays 0; May 11, 2001, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the employment of Medicaid recipients and to the
1-9 enrollment of Medicaid recipients and state child health plan
1-10 enrollees in certain group health benefit plans.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. Subchapter B, Chapter 62, Health and Safety Code,
1-13 is amended by adding Section 62.059 to read as follows:
1-14 Sec. 62.059. HEALTH INSURANCE PREMIUM PAYMENT REIMBURSEMENT
1-15 PROGRAM FOR CHILDREN ELIGIBLE FOR CHILD HEALTH PLAN. (a) In this
1-16 section, "group health benefit plan" has the meaning assigned by
1-17 Article 21.52K, Insurance Code.
1-18 (b) Under the direction of the commission, the Texas
1-19 Department of Health shall identify children, otherwise eligible to
1-20 enroll in the state child health plan under this chapter, who are
1-21 eligible to enroll in a group health benefit plan.
1-22 (c) For a child identified under Subsection (b), the
1-23 department shall determine whether it is cost-effective to enroll
1-24 the child in the group health benefit plan under this section.
1-25 (d) If the department determines that it is cost-effective
1-26 to enroll the child in the group health benefit plan, the
1-27 department shall:
1-28 (1) require the child to apply to enroll in the group
1-29 health benefit plan as a condition for eligibility under this
1-30 chapter; and
1-31 (2) provide written notice to the issuer of the group
1-32 health benefit plan in accordance with Article 21.52K, Insurance
1-33 Code.
1-34 (e) The department shall provide for payment of the
1-35 employee's share of required premiums for coverage of a child
1-36 enrolled in the group health benefit plan.
1-37 (f) In addition to any amount paid under Subsection (e), the
1-38 department may provide for the payment of a group health benefit
1-39 plan premium for the child's parent or for an individual who is a
1-40 member of the child's family if:
1-41 (1) the child is not eligible to be enrolled in the
1-42 group health benefit plan unless the other individual is also
1-43 enrolled in the plan; and
1-44 (2) the department determines it to be cost-effective.
1-45 (g) The department may not provide for the payment of any
1-46 deductible, copayment, coinsurance, or other cost-sharing
1-47 obligation for the child or another individual enrolled in a group
1-48 health benefit plan under Subsection (f).
1-49 (h) Enrollment of a child in a group health benefit plan
1-50 under this chapter does not affect the child's eligibility for
1-51 benefits under this chapter, except that the program is the payor
1-52 of last resort for those benefits.
1-53 (i) The department may consolidate or coordinate the
1-54 administration of the program provided under this section with a
1-55 similar program provided under Section 32.0422, Human Resources
1-56 Code, for individuals eligible for medical assistance under the
1-57 state Medicaid program.
1-58 SECTION 2. Subchapter B, Chapter 32, Human Resources Code, is
1-59 amended by adding Section 32.0422 to read as follows:
1-60 Sec. 32.0422. HEALTH INSURANCE PREMIUM PAYMENT REIMBURSEMENT
1-61 PROGRAM FOR MEDICAL ASSISTANCE RECIPIENTS. (a) In this section:
1-62 (1) "Department" means the Texas Department of Health.
1-63 (2) "Group health benefit plan" has the meaning
1-64 assigned by Article 21.52K, Insurance Code.
2-1 (b) The department shall identify individuals, otherwise
2-2 entitled to medical assistance, who are eligible to enroll in a
2-3 group health benefit plan. The department must include individuals
2-4 eligible for or receiving health care services under a Medicaid
2-5 managed care delivery system.
2-6 (c) The department shall require an individual requesting
2-7 medical assistance to provide information as necessary relating to
2-8 the availability of a group health benefit plan to the individual
2-9 through an employer of the individual or an employer of the
2-10 individual's spouse or parent.
2-11 (d) For an individual identified under Subsection (b), the
2-12 department shall determine whether it is cost-effective to enroll
2-13 the individual in the group health benefit plan under this section.
2-14 (e) If the department determines that it is cost-effective
2-15 to enroll the individual in the group health benefit plan, the
2-16 department shall:
2-17 (1) require the individual to apply to enroll in the
2-18 group health benefit plan as a condition for eligibility under the
2-19 medical assistance program; and
2-20 (2) provide written notice to the issuer of the group
2-21 health benefit plan in accordance with Article 21.52K, Insurance
2-22 Code.
2-23 (f) The department shall provide for payment of:
2-24 (1) the employee's share of required premiums for
2-25 coverage of an individual enrolled in the group health benefit
2-26 plan; and
2-27 (2) any deductible, copayment, coinsurance, or other
2-28 cost-sharing obligation imposed on the enrolled individual for an
2-29 item or service otherwise covered under the medical assistance
2-30 program.
2-31 (g) A payment made by the department under Subsection (f) is
2-32 considered to be a payment for medical assistance.
2-33 (h) A payment of a premium for an individual who is a member
2-34 of the family of an individual enrolled in a group health benefit
2-35 plan under this section and who is not eligible for medical
2-36 assistance is considered to be a payment for medical assistance for
2-37 an eligible individual if:
2-38 (1) enrollment of the family members who are eligible
2-39 for medical assistance is not possible under the plan without also
2-40 enrolling members who are not eligible; and
2-41 (2) the department determines it to be cost-effective.
2-42 (i) A payment of any deductible, copayment, coinsurance, or
2-43 other cost-sharing obligation of a family member who is enrolled in
2-44 a group health benefit plan in accordance with Subsection (h) and
2-45 who is not eligible for medical assistance:
2-46 (1) may not be paid under this chapter; and
2-47 (2) is not considered to be a payment for medical
2-48 assistance for an eligible individual.
2-49 (j) The department shall treat coverage under the group
2-50 health benefit plan as a third party liability to the program.
2-51 Enrollment of an individual in a group health benefit plan under
2-52 this section does not affect the individual's eligibility for
2-53 medical assistance benefits, except that the state is entitled to
2-54 payment under Sections 32.033 and 32.038.
2-55 (k) The department may not require or permit an individual
2-56 who is enrolled in a group health benefit plan under this section
2-57 to participate in the Medicaid managed care program under Chapter
2-58 533, Government Code, or a Medicaid managed care demonstration
2-59 project under Section 32.041.
2-60 (l) The Texas Department of Human Services shall provide
2-61 information and otherwise cooperate with the department as
2-62 necessary to ensure the enrollment of eligible individuals in the
2-63 group health benefit plan under this section.
2-64 (m) The department may consolidate or coordinate the
2-65 administration of the program provided under this section with a
2-66 similar program provided under Section 62.059, Health and Safety
2-67 Code, for children eligible for the state child health plan.
2-68 (n) The department shall adopt rules as necessary to
2-69 implement this section.
3-1 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
3-2 amended by adding Article 21.52K to read as follows:
3-3 Art. 21.52K. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND
3-4 CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN
3-5 Sec. 1. DEFINITION OF GROUP HEALTH BENEFIT PLAN. (a) In
3-6 this article, "group health benefit plan" means a plan that
3-7 provides benefits for medical or surgical expenses incurred as a
3-8 result of a health condition, accident, or sickness, including a
3-9 group, blanket, or franchise insurance policy or insurance
3-10 agreement, a group hospital service contract, or a group evidence
3-11 of coverage or similar group coverage document that is offered by:
3-12 (1) an insurance company;
3-13 (2) a group hospital service corporation operating
3-14 under Chapter 20 of this code;
3-15 (3) a fraternal benefit society operating under
3-16 Chapter 10 of this code;
3-17 (4) a stipulated premium insurance company operating
3-18 under Chapter 22 of this code;
3-19 (5) a reciprocal exchange operating under Chapter 19
3-20 of this code;
3-21 (6) a health maintenance organization operating under
3-22 the Texas Health Maintenance Organization Act (Chapter 20A,
3-23 Vernon's Texas Insurance Code);
3-24 (7) a multiple employer welfare arrangement that holds
3-25 a certificate of authority under Article 3.95-2 of this code; or
3-26 (8) an approved nonprofit health corporation that
3-27 holds a certificate of authority under Article 21.52F of this code.
3-28 (b) The term "group health benefit plan" includes:
3-29 (1) a small employer health benefit plan written under
3-30 Chapter 26 of this code; and
3-31 (2) a plan provided under the Texas Employees Uniform
3-32 Group Insurance Benefits Act (Article 3.50-2, Vernon's Texas
3-33 Insurance Code), the Texas State College and University Employees
3-34 Uniform Insurance Benefits Act (Article 3.50-3, Vernon's Texas
3-35 Insurance Code), the Texas Public School Employees Group Insurance
3-36 Act (Article 3.50-4, Vernon's Texas Insurance Code), or a successor
3-37 of any of those plans.
3-38 Sec. 2. ENROLLMENT REQUIRED. (a) The issuer of a group
3-39 health benefit plan, on receipt of written notice from the Texas
3-40 Department of Health or a designee of the Texas Department of
3-41 Health that states that an individual who is otherwise eligible for
3-42 enrollment in the plan is a recipient of medical assistance under
3-43 the state Medicaid program and is a participant in the health
3-44 insurance premium payment reimbursement program for medical
3-45 assistance recipients under Section 32.044, Human Resources Code,
3-46 shall permit the individual to enroll in the plan without regard to
3-47 any enrollment period restriction.
3-48 (b) The issuer of a group health benefit plan, on receipt of
3-49 written notice from the Texas Department of Health or a designee of
3-50 the Texas Department of Health that states that a child who is
3-51 otherwise eligible for enrollment in the plan is enrolled in the
3-52 state child health plan under Chapter 62, Health and Safety Code,
3-53 and is a participant in the health insurance premium payment
3-54 reimbursement program under Section 62.059, Health and Safety Code,
3-55 provided for children eligible for the state child health plan
3-56 shall permit the child to enroll in the group health benefit plan
3-57 without regard to any enrollment period restriction.
3-58 (c) If an individual described by Subsection (a) or (b) of
3-59 this section is not eligible to enroll in the plan unless a family
3-60 member of the individual is also enrolled in the plan, the issuer,
3-61 on receipt of the written notice under Subsection (a) or (b) of
3-62 this section, shall enroll both the individual and the family
3-63 member in the plan.
3-64 (d) Unless enrollment occurs during an established
3-65 enrollment period, enrollment under this article takes effect on
3-66 the first day of the calendar month that begins at least 30 days
3-67 after the date written notice is received by the issuer under
3-68 Subsection (a) or (b) of this section.
3-69 (e) Notwithstanding any other requirement of the group
4-1 health benefit plan, the issuer of the plan shall permit an
4-2 individual who is enrolled in a group health benefit plan under
4-3 Subsection (a) of this section, and any family member of the
4-4 individual enrolled under Subsection (c) of this section, to
4-5 terminate enrollment in the plan not later than the 60th day after
4-6 the date on which the individual provides satisfactory proof to the
4-7 issuer that the individual is no longer:
4-8 (1) a recipient of medical assistance under the state
4-9 Medicaid program; or
4-10 (2) a participant in the health insurance premium
4-11 payment program for medical assistance recipients under Section
4-12 32.0422, Human Resources Code.
4-13 (f) Notwithstanding any other requirement of the group
4-14 health benefit plan, the issuer of the plan shall permit an
4-15 individual who is enrolled in a group health benefit plan under
4-16 Subsection (b) of this section, and any family member of the
4-17 individual enrolled under Subsection (c) of this section, to
4-18 terminate enrollment in the plan not later than the 60th day after
4-19 the date on which the individual provides satisfactory proof to the
4-20 issuer that the child is no longer a participant in the health
4-21 insurance premium payment program under Section 62.059, Health and
4-22 Safety Code, provided for children eligible for the state child
4-23 health plan.
4-24 SECTION 4. Section 301.104, Labor Code, is amended to read as
4-25 follows:
4-26 Sec. 301.104. ELIGIBILITY. A person is eligible for the
4-27 refund for wages paid or incurred by the person, during each
4-28 calendar year for which the refund is claimed, only if:
4-29 (1) the wages paid or incurred by the person are for
4-30 services of an employee who is:
4-31 (A) a resident of this state; and
4-32 (B) a recipient of:
4-33 (i) financial assistance and services in
4-34 accordance with Chapter 31, Human Resources Code; or
4-35 (ii) medical assistance in accordance with
4-36 Chapter 32, Human Resources Code;
4-37 (2) the person satisfies the certification
4-38 requirements under Section 301.105; and
4-39 (3) the person provides and pays for the benefit of
4-40 the employee a part of the cost of coverage under:
4-41 (A) a health plan provided by a health
4-42 maintenance organization established under the Texas Health
4-43 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-44 Code);
4-45 (B) a health benefit plan approved by the
4-46 commissioner of insurance; [or]
4-47 (C) a self-funded or self-insured employee
4-48 welfare benefit plan that provides health benefits and is
4-49 established in accordance with the Employee Retirement Income
4-50 Security Act of 1974 (29 U.S.C. 1001 et seq.); or
4-51 (D) a medical savings account authorized under
4-52 the Health Insurance Portability and Accountability Act of 1996 (26
4-53 U.S.C. Section 220).
4-54 SECTION 5. (a) The Texas Department of Health shall study:
4-55 (1) various options for increasing enrollment in a
4-56 group health benefit plan under Section 32.0422, Human Resources
4-57 Code, as added by this Act; and
4-58 (2) the feasibility of implementing an income-based
4-59 sliding scale requiring payment of a portion of the plan premium
4-60 from a person who:
4-61 (A) is receiving transitional medical assistance
4-62 under Section 32.0255, Human Resources Code;
4-63 (B) is employed; and
4-64 (C) is eligible for and enrolled in a group
4-65 health benefit plan described by Subdivision (1) of this section.
4-66 (b) Not later than December 1, 2002, the Texas Department of
4-67 Health shall report its conclusions and recommendations regarding
4-68 the study conducted under Subsection (a) of this section to the
4-69 governor, lieutenant governor, speaker of the house of
5-1 representatives, and presiding officer of each standing committee
5-2 of the senate and house of representatives having jurisdiction over
5-3 health and human services issues.
5-4 SECTION 6. A person may claim a refund under Section 301.104,
5-5 Labor Code, as amended by this Act, only for wages paid or incurred
5-6 on or after the effective date of this Act.
5-7 SECTION 7. If before implementing any provision of this Act a
5-8 state agency determines that a waiver or authorization from a
5-9 federal agency is necessary for implementation, the state agency
5-10 shall request the waiver or authorization and may delay
5-11 implementing that provision until the waiver or authorization is
5-12 granted.
5-13 SECTION 8. (a) The Health and Human Services Commission
5-14 shall, not later than September 15, 2001, submit for approval a
5-15 plan amendment relating to the state child health plan under 42
5-16 U.S.C. Section 1397ff, as amended, as necessary to comply with the
5-17 change in law made by this Act.
5-18 (b) The Health and Human Services Commission may delay,
5-19 until approval of the amended state child health plan,
5-20 implementation of the health insurance premium payment
5-21 reimbursement program under Section 62.059, Health and Safety Code,
5-22 as added by this Act.
5-23 SECTION 9. (a) Except as provided by Subsection (b) of this
5-24 section, this Act takes effect September 1, 2001.
5-25 (b) The changes in law made by Sections 1, 2, and 3 of this
5-26 Act take effect August 31, 2001, and apply only to a group health
5-27 benefit plan that is delivered, issued for delivery, or renewed on
5-28 or after that date. A group health benefit plan that is delivered,
5-29 issued for delivery, or renewed before August 31, 2001, is
5-30 governed by the law as it existed immediately before that date, and
5-31 that law is continued in effect for that purpose.
5-32 * * * * *