2005S0001-1 10/22/04
By: Averitt S.B. No. 59
A BILL TO BE ENTITLED
AN ACT
relating to eligibility for and the administration of the child
health plan program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subdivision (4), Section 62.002, Health and
Safety Code, is amended to read as follows:
(4) "Net [Gross] family income" means the [total]
amount of income established for a family after reduction for
offsets for expenses such as child care and work-related expenses,
in accordance with standards applicable under the Medicaid [without
consideration of any reduction for offsets that may be available to
the family under any other] program.
SECTION 2. Subchapter B, Chapter 62, Health and Safety
Code, is amended by adding Sections 62.056 and 62.057 to read as
follows:
Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE
HOTLINE. (a) The commission shall conduct a community outreach
and education campaign to provide information relating to the
availability of health benefits for children under this chapter.
The commission shall conduct the campaign in a manner that promotes
enrollment in, and minimizes duplication of effort among, all
state-administered child health programs.
(b) The community outreach campaign must include:
(1) outreach efforts that involve school-based health
clinics; and
(2) a toll-free telephone number through which
families may obtain information about health benefits coverage for
children.
(c) The commission shall contract with community-based
organizations or coalitions of community-based organizations to
implement the community outreach campaign and shall also promote
and encourage voluntary efforts to implement the community outreach
campaign. The commission shall procure the contracts through a
process designed by the commission to encourage broad participation
of organizations, including organizations that target population
groups with high levels of uninsured children.
(d) The commission may direct that the Department of State
Health Services perform all or part of the community outreach
campaign.
Sec. 62.057. REGIONAL ADVISORY COMMITTEES. (a) The
commission shall appoint regional advisory committees to provide
recommendations on the operation of the child health plan program.
(b) The advisory committees, to the extent possible, must be
composed of representatives of:
(1) hospitals;
(2) insurance companies and health maintenance
organizations eligible to offer the health benefits coverage under
the child health plan;
(3) primary care providers;
(4) consumer advocates, including advocates for
children with special health care needs;
(5) parents of children who are enrolled in the child
health plan;
(6) rural health care providers;
(7) specialty health care providers, including
pediatric providers;
(8) community-based organizations that provide
community outreach under Section 62.056; and
(9) state agencies.
(c) The commission shall establish the regional advisory
committees, consistent with Subsection (b), in regions of this
state in a manner that ensures geographic representation.
(d) In implementing this section, the commission may use
other regional advisory structures, augmented to ensure the
representation required by Subsection (b), to the extent necessary
to avoid duplication of administrative activities.
(e) The advisory committees shall meet at least quarterly
and are subject to Chapter 551, Government Code.
(f) Section 2110.008, Government Code, does not apply to the
advisory committees.
SECTION 3. Subsection (b), Section 62.101, Health and
Safety Code, is amended to read as follows:
(b) The commission shall establish income eligibility
levels consistent with Title XXI, Social Security Act (42 U.S.C.
Section 1397aa et seq.), as amended, and any other applicable law or
regulations, and subject to the availability of appropriated money,
so that a child who is younger than 19 years of age and whose net
[gross] family income is at or below 200 percent of the federal
poverty level is eligible for health benefits coverage under the
program. [In addition, the commission may establish eligibility
standards regarding the amount and types of allowable assets for a
family whose gross family income is above 150 percent of the federal
poverty level.]
SECTION 4. Subsection (b), Section 62.1015, Health and
Safety Code, is amended to read as follows:
(b) A child of an employee of a charter school, school
district, other educational district whose employees are members of
the Teacher Retirement System of Texas, or regional education
service center may be enrolled in health benefits coverage under
the child health plan. A child enrolled in the child health plan
under this section[:
[(1)] participates in the same manner as any other
child enrolled in the child health plan[; and
[(2) is subject to the same requirements and
restrictions relating to income eligibility, continuous coverage,
and enrollment, including applicable waiting periods, as any other
child enrolled in the child health plan].
SECTION 5. Section 62.102, Health and Safety Code, is
amended to read as follows:
Sec. 62.102. CONTINUOUS COVERAGE. [(a)] The commission
shall provide that an individual who is determined to be eligible
for coverage under the child health plan remains eligible for those
benefits until the earlier of:
(1) the end of a period, not to exceed 12 months,
following the date of the eligibility determination; or
(2) the individual's 19th birthday.
[(b) The period of continuous eligibility may be
established at an interval of 6 months beginning immediately upon
passage of this Act and ending September 1, 2005, at which time an
interval of 12 months of continuous eligibility will be
re-established.]
SECTION 6. Subsection (b), Section 62.153, Health and
Safety Code, is amended to read as follows:
(b) Cost-sharing [Subject to Subsection (d), cost-sharing]
provisions adopted under this section shall ensure that families
with higher levels of income are required to pay progressively
higher percentages of the cost of the plan.
SECTION 7. The heading to Section 62.154, Health and Safety
Code, is amended to read as follows:
Sec. 62.154. [WAITING PERIOD;] CROWD OUT.
SECTION 8. Subsections (a), (b), and (d), Section 62.154,
Health and Safety Code, are amended to read as follows:
(a) To the extent permitted under Title XXI of the Social
Security Act (42 U.S.C. Section 1397aa et seq.), as amended, and any
other applicable law or regulations, the child health plan must
include a waiting period and[. The child health plan] may include
copayments and other provisions intended to discourage:
(1) employers and other persons from electing to
discontinue offering coverage for children under employee or other
group health benefit plans; and
(2) individuals with access to adequate health benefit
plan coverage, other than coverage under the child health plan,
from electing not to obtain or to discontinue that coverage for a
child.
(b) A child is not subject to a waiting period adopted under
Subsection (a) if:
(1) the family lost coverage for the child as a result
of:
(A) termination of employment because of a layoff
or business closing;
(B) termination of continuation coverage under
the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L.
No. 99-272);
(C) change in marital status of a parent of the
child;
(D) termination of the child's Medicaid
eligibility because:
(i) the child's family's earnings or
resources increased; or
(ii) the child reached an age at which
Medicaid coverage is not available; or
(E) a similar circumstance resulting in the
involuntary loss of coverage;
(2) the family terminated health benefits plan
coverage for the child because the cost to the child's family for
the coverage exceeded 10 percent of the family's net income; or
(3) [the child has access to group-based health
benefits plan coverage and is required to participate in the health
insurance premium payment reimbursement program administered by
the commission; or
[(4)] the commission has determined that other grounds
exist for a good cause exception.
(d) The waiting period required by Subsection (a) must:
(1) extend for a period of 90 days after[:
[(1)] the last date on [first day of the month in]
which the applicant was covered under a health benefits plan; and
(2) apply to a child who was covered by a health
benefits plan at any time during the 90 days before the date of
application for coverage under the child health plan [is enrolled
under the child health plan, if the date of enrollment is on or
before the 15th day of the month; or
[(2) the first day of the month after which the
applicant is enrolled under the child health plan, if the date of
enrollment is after the 15th day of the month].
SECTION 9. Subsections (c) and (d), Section 62.155, Health
and Safety Code, are amended to read as follows:
(c) In selecting a health plan provider, the commission:
(1) may give preference to a person who provides
similar coverage under the Medicaid program; and
(2) shall provide for a choice of at least two health
plan providers in each metropolitan [service] area.
(d) The commissioner may authorize an exception to
Subsection (c)(2) if there is only one acceptable applicant to
become a health plan provider in the metropolitan [service] area.
SECTION 10. Subsection (d), Section 62.153, Health and
Safety Code, is repealed.
SECTION 11. This Act takes effect September 1, 2005.