Amend CSSB 10 by inserting the following sections,
appropriately numbered, and renumbering sections of the bill
accordingly:
SECTION ____. Subtitle C, Title 2, Health and Safety Code,
is amended by adding Chapter 75 to read as follows:
CHAPTER 75. REGIONAL OR LOCAL HEALTH CARE PROGRAMS FOR EMPLOYEES OF
SMALL EMPLOYERS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 75.001. PURPOSE. The purpose of this chapter is to:
(1) improve the health of employees of small employers
and their families by improving the employees' access to health
care and by reducing the number of those employees who are
uninsured;
(2) reduce the likelihood that those employees and
their families will require services from state-funded entitlement
programs such as Medicaid;
(3) contribute to economic development by helping
small businesses remain competitive with a healthy workforce and
health care benefits that will attract employees; and
(4) encourage innovative solutions for providing and
funding health care services and benefits.
Sec. 75.002. DEFINITIONS. In this chapter:
(1) "Employee" means an individual employed by an
employer. The term includes a partner of a partnership and the
proprietor of a sole proprietorship.
(2) "Governing body" means:
(A) the commissioners courts of the counties
participating in a regional health care program;
(B) the commissioners court of a county
participating in a local health care program; or
(C) the governing body of the joint council,
nonprofit entity exempt from federal taxation, or other entity that
operates a regional or local health care program.
(3) "Local health care program" means a local health
care program operating in one county and established for the
benefit of the employees of small employers under Subchapter B.
(4) "Regional health care program" means a regional
health care program operating in two or more counties and
established for the benefit of the employees of small employers
under Subchapter B.
(5) "Small employer" means a person who employed an
average of at least two employees but not more than 50 employees on
business days during the preceding calendar year and who employs at
least two employees on the first day of the plan year.
[Sections 75.003-75.050 reserved for expansion]
SUBCHAPTER B. REGIONAL OR LOCAL HEALTH CARE PROGRAM
Sec. 75.051. ESTABLISHMENT OF PROGRAM; MULTICOUNTY
COOPERATION. (a) The commissioners court of a county may, by
order, establish or participate in a local health care program
under this subchapter.
(b) The commissioners courts of two or more counties may, by
joint order, establish or participate in a regional health care
program under this subchapter.
Sec. 75.052. GOVERNANCE OF PROGRAM. (a) A regional health
care program may be operated subject to the direct governance of the
commissioners courts of the participating counties. A local health
care program may be operated subject to the direct governance of the
commissioners court of the participating county. A regional or
local health care program may be operated by a joint council,
tax-exempt nonprofit entity, or other entity that:
(1) operates the program under a contract with the
commissioners court or courts, as applicable; or
(2) is an entity in which the county or counties
participate or that is established or designated by the
commissioners court or courts, as applicable, to operate the
program.
(b) In selecting an entity described by Subsection (a)(1) or
(2) to operate a regional or local health care program, the
commissioners court or courts, as applicable, shall require, to the
extent possible, that the entity be authorized under federal law to
accept donations on a basis that is tax-deductible or otherwise
tax-advantaged for the contributor.
Sec. 75.053. OPERATION OF PROGRAM. A regional or local
health care program provides health care services or benefits to
the employees of participating small employers who are located
within the boundaries of the participating county or counties, as
applicable. A program may also provide services or benefits to the
dependents of those employees.
Sec. 75.054. PARTICIPATION BY SMALL EMPLOYERS; SHARE OF
COST. The governing body may establish criteria for participation
in a regional or local health care program by small employers, the
employees of the small employers, and their dependents. The
criteria must require that participating employers and
participating employees pay a share of the premium or other cost of
the program.
Sec. 75.055. ADDITIONAL FUNDING. (a) A governing body may
accept and use a gift, grant, or donation from any source to operate
the regional or local health care program and to provide services or
benefits under the program.
(a-1) A governing body may apply for and receive a grant
under Subchapter D to support a regional or local health care
program. This subsection expires September 1, 2009.
(b) A governing body shall actively solicit gifts, grants,
and donations to:
(1) fund services and benefits provided under the
regional or local health care program; and
(2) reduce the cost of participation in the program
for small employers and their employees.
[Sections 75.056-75.100 reserved for expansion]
SUBCHAPTER C. HEALTH CARE SERVICES AND BENEFITS
Sec. 75.101. ALTERNATIVE PROGRAMS AUTHORIZED; PROGRAM
OBJECTIVES. In developing a regional or local health care program,
a governing body may provide health care services or benefits as
described by this subchapter or may develop another type of program
to accomplish the purposes of this chapter. A regional or local
health care program must be developed, to the extent practicable,
to:
(1) reduce the number of individuals without health
benefit plan coverage within the boundaries of the participating
county or counties;
(2) address rising health care costs and reduce the
cost of health care services or health benefit plan coverage for
small employers and their employees within the boundaries of the
participating county or counties;
(3) promote preventive care and reduce the incidence
of preventable health conditions, such as heart disease, cancer,
and diabetes and low birth weight in infants;
(4) promote efficient and collaborative delivery of
health care services;
(5) serve as a model for the innovative use of health
information technology to promote efficient delivery of health care
services, reduce health care costs, and improve the health of the
community; and
(6) provide fair payment rates for health care
providers.
Sec. 75.102. HEALTH BENEFIT PLAN COVERAGE. (a) A regional
or local health care program may provide health care benefits to the
employees of small employers by purchasing or facilitating the
purchase of health benefit plan coverage for those employees from a
health benefit plan issuer, including coverage under:
(1) a small employer health benefit plan offered under
Chapter 1501, Insurance Code;
(2) a standard health benefit plan offered under
Chapter 1507, Insurance Code; or
(3) any other health benefit plan available in this
state.
(b) The governing body may form one or more cooperatives
under Subchapter B, Chapter 1501, Insurance Code.
(c) Notwithstanding Chapter 1251, Insurance Code, an
insurer may issue a group accident and health insurance policy,
including a group contract issued by a group hospital service
corporation, to cover the employees of small employers
participating in a regional or local health care program. The group
policyholder of a policy issued in accordance with this subsection
is the governing body or the designee of the governing body.
(d) A health maintenance organization may issue a health
care plan to cover the employees of small employers participating
in a regional or local health care program. The group contract
holder of a contract issued in accordance with this subsection is
the governing body or the designee of the governing body.
Sec. 75.103. OTHER HEALTH BENEFIT PLANS OR PROGRAMS. To the
extent authorized by federal law, the governing body may establish
or facilitate the establishment of self-funded health benefit plans
or may facilitate the provision of health benefit coverage through
health savings accounts and high-deductible health plans.
Sec. 75.104. HEALTH CARE SERVICES. (a) A regional or local
health care program may contract with health care providers within
the boundaries of the participating county or counties to provide
health care services directly to the employees of participating
small employers and the dependents of those employees.
(b) A regional or local health care program shall allow any
individual who receives state premium assistance to buy into the
health benefit plan offered by the regional or local health care
program.
(c) A governing body that operates a regional or local
health care program under this section may require that
participating employees and dependents obtain health care services
only from health care providers that contract to provide those
services under the program and may limit the health care services
provided under the program to services provided within the
boundaries of the participating county or counties.
(d) A governing body operating a regional or local health
care program operated under this section is not an insurer or health
maintenance organization and the program is not subject to
regulation by the Texas Department of Insurance.
[Sections 75.105-75.150 reserved for expansion]
SUBCHAPTER D. GRANTS FOR DEMONSTRATION PROJECTS
Sec. 75.151. DEFINITIONS. In this subchapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Executive commissioner" means the executive
commissioner of the commission.
Sec. 75.152. GRANT PROGRAM. (a) The executive
commissioner may establish a grant program to support the initial
establishment and operation of one or more regional or local health
care programs as demonstration projects.
(b) In selecting grant recipients, the executive
commissioner shall consider the extent to which the regional or
local health care program proposed by the applicant accomplishes
the purposes of this chapter and meets the objectives established
under Section 75.101.
(c) The commission shall establish performance objectives
for a grant recipient and shall monitor the performance of the grant
recipient.
Sec. 75.153. REVIEW OF DEMONSTRATION PROJECT; REPORT. Not
later than December 1, 2008, the commission shall complete a review
of each regional or local health care program that receives a grant
under this subchapter and shall submit to the governor, the
lieutenant governor, and the speaker of the house of
representatives a report that includes:
(1) an evaluation of the success of regional and local
health care programs in accomplishing the purposes of this chapter;
and
(2) the commission's recommendations for any
legislation needed to facilitate or improve regional and local
health care programs.
Sec. 75.154. EXPIRATION. This subchapter expires September
1, 2009.
SECTION ____. The heading to Subtitle C, Title 2, Health and
Safety Code, is amended to read as follows:
SUBTITLE C. PROGRAMS PROVIDING [INDIGENT] HEALTH CARE BENEFITS AND
SERVICES