78R3655 KEG-F

By:  Lindsay                                                      S.B. No. 690



A BILL TO BE ENTITLED

AN ACT

relating to the disenrollment of certain persons eligible for 
supplemental security income from the child health plan and 
Medicaid managed care programs.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter C, Chapter 62, Health and Safety 
Code, is amended by adding Section 62.106 to read as follows:
	Sec. 62.106.  DISENROLLMENT OF CHILDREN ELIGIBLE FOR 
SUPPLEMENTAL SECURITY INCOME (SSI).  (a)  Not later than the 21st 
day after the date the commission receives notice from the federal 
Social Security Administration that a child enrolled in the child 
health plan is eligible for Supplemental Security Income (SSI) (42 
U.S.C. Section 1381 et seq.), as amended, the commission shall:
		(1)  disenroll the child from the child health plan 
retroactive to the date the child became eligible for Supplemental 
Security Income (SSI), as determined by the Social Security 
Administration;
		(2)  provide to the child's parent or guardian 
information about enrolling in the medical assistance program under 
Chapter 32, Human Resources Code, or voluntarily enrolling in the 
Medicaid managed care program under Chapter 533, Government Code, 
if available in the child's health care service region; and
		(3)  reimburse a health plan provider for any payments 
made by the provider to a health care provider for services that are 
delivered to the child under the child health plan on or after the 
date the child became eligible for Supplemental Security Income 
(SSI), as determined by the Social Security Administration.
	(b)  To be eligible for reimbursement under Subsection 
(a)(3), a health plan provider must refund to the commission any 
capitation payments received to provide health benefits coverage 
for the child for a period on or after the date the child became 
eligible for Supplemental Security Income (SSI).
	SECTION 2.  Section 533.0076, Government Code, is amended by 
adding Subsection (d) to read as follows:
	(d)  This section does not prohibit the commission from 
disenrolling a recipient under Section 533.0077.
	SECTION 3.  Subchapter A, Chapter 533, Government Code, is 
amended by adding Section 533.0077 to read as follows:
	Sec. 533.0077.  DISENROLLMENT OF RECIPIENTS WHO ARE ELIGIBLE 
FOR SUPPLEMENTAL SECURITY INCOME (SSI).  (a)  Not later than the 
21st day after the date the commission receives notice from the 
federal Social Security Administration that a recipient enrolled in 
a managed care plan under this chapter is eligible for Supplemental 
Security Income (SSI) (42 U.S.C. Section 1381 et seq.), as amended, 
the commission shall:
		(1)  disenroll the recipient from the managed care plan 
retroactive to the date the recipient became eligible for 
Supplemental Security Income (SSI), as determined by the Social 
Security Administration;
		(2)  provide to the recipient or, if the recipient is a 
child, to the recipient's parent or guardian, information about 
enrolling in the medical assistance program under Chapter 32, Human 
Resources Code, or voluntarily re-enrolling in a managed care plan 
under this chapter; and
		(3)  reimburse a managed care organization for any 
payments made by the organization to a health care provider for 
services that are delivered to the recipient under the managed care 
plan on or after the date the recipient became eligible for 
Supplemental Security Income (SSI), as determined by the Social 
Security Administration.
	(b)  To be eligible for reimbursement under Subsection 
(a)(3), a managed care organization must refund to the commission 
any capitation payments received to provide health benefits 
coverage for the recipient for a period on or after the date the 
recipient became eligible for Supplemental Security Income (SSI), 
as determined by the Social Security Administration.
	SECTION 4.  (a)  Not later than October 1, 2003, the Health 
and Human Services Commission shall determine:
		(1)  whether a waiver or authorization from a federal 
agency is necessary to implement a provision of this Act; and
		(2)  whether the commission must amend the capitation 
payment rates for health plan providers under Chapter 62, Health 
and Safety Code, or managed care organizations under Chapter 533, 
Government Code, to implement this Act.
	(b)  If the commission determines that a waiver or 
authorization is necessary or a capitation payment rate must be 
amended, the commission shall, not later than March 1, 2004:
		(1)  adopt rules necessary to facilitate the waiver or 
authorization or to amend the capitation payment rates; and
		(2)  seek any necessary waiver or authorization from 
the federal government after adopting rules under Subdivision (1) 
of this subsection, if any.
	(c)  The commission may delay implementing a provision of 
this Act until the commission receives a necessary waiver or 
authorization from the federal government.
	SECTION 5.  This Act takes effect September 1, 2003.