80R6963 ABC-D

By: Coleman H.B. No. 2863

A BILL TO BE ENTITLED

AN ACT

relating to coverage for health care for Texans.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

ARTICLE 1. GENERAL PROVISIONS

SECTION 1.01. FINDINGS. (a) The growing ranks of uninsured Texans pose a critical threat to the physical health of all Texans, as well as the state's economy. The lack of coverage for health care contributes to a sicker, less productive population and to a higher tax burden for businesses, home owners, and individuals.

(b) Texas has the highest percentage of uninsured individuals in the nation. One in four Texans, 5.6 million people, lack coverage for health care. Seventy-nine percent of uninsured adult Texans are part of the workforce or have a family member in the workforce, while 1.4 million children, 21 percent of the population, lack coverage for health care.

(c) Texas workers are less likely to have employment-based coverage for health care than workers in other states. Only 55 percent of Texans have access to employer-sponsored coverage for health care, while only 37 percent of Texans who work in the small businesses that make up the majority of Texas employers have access to employer-sponsored coverage for health care.

(d) While Medicaid and the state child health plan are cost-effective programs to help working parents provide health insurance for their children, an estimated 700,000 children are eligible for Medicaid and the state child health plan but are not enrolled. Given the generous federal matching dollars, Medicaid and the state child health plan are cost-effective ways for the state to help working parents provide health care coverage for their children.

(e) The state Medicaid program pays physicians the lowest reimbursement among all payers. While Medicaid enrollment has increased, only 38 percent of Texas physicians accept new Medicaid patients, forcing these patients to rely on expensive, already overcrowded emergency rooms for their care.

(f) For Texas to compete economically at home and abroad, the state must invest in a healthy population and workforce, which includes ensuring that all Texans can obtain affordable, timely health care.

SECTION 1.02. PURPOSE. The purpose of this Act is to implement commonsense, cost-effective strategies to ensure that Texas families and businesses have access to affordable health care.

SECTION 1.03. DEFINITION. In this Act, "commission" means the Health and Human Services Commission.

SECTION 1.04. RULES; IMPLEMENTATION. Notwithstanding any other law, the executive commissioner of the commission, the comptroller, the commissioner of insurance, the board of directors of the Texas Health Insurance Risk Pool, and the Texas Higher Education Coordinating Board shall by rule implement the requirements of this Act.

ARTICLE 2. MEDICAID

SECTION 2.01. MEDICAID ENROLLMENT AND RENEWAL. (a) The commission shall ensure that all children who are eligible for the Medicaid program are enrolled in that program.

(b) The commission shall establish a 12-month period of continuous eligibility for the Medicaid program.

SECTION 2.02. MEDICAID OUTREACH AND EDUCATION. (a) The commission shall establish a broad outreach campaign to educate families about the availability of affordable coverage for health care for their children, including Medicaid, and the importance of coverage for health care in ensuring their children get the preventive and primary care services they need.

(b) The commission shall establish and promote an outreach program under which:

(1) emergency department personnel distribute Medicaid applications when uninsured children are treated in the emergency department;

(2) public schools provide information about Medicaid at the beginning of the school year in connection with enrollment in programs for free or reduced price lunches; and

(3) information about Medicaid is made available to parents who are applying for public assistance programs such as food stamps.

SECTION 2.03. MEDICAID HEALTH INSURANCE PREMIUM PROGRAM. The commission shall expand the Medicaid health insurance premium program to use Medicaid funds to subsidize private coverage for health care for working individuals who would otherwise qualify for Medicaid so that more Medicaid eligible workers who have access to, but cannot afford, employer-sponsored coverage may acquire and retain this coverage.

SECTION 2.04. ADULT MEDICALLY NEEDY PROGRAM. The commission shall reestablish the medically needy program that serves pregnant women, children, and caretakers who have high medical expenses. At a minimum, the program must serve recipients, including adult recipients, in the same manner and at the same level that services were provided to recipients under the medically needy program during the state fiscal biennium ending August 31, 2003.

SECTION 2.05. EXPAND MEDICAID ELIGIBILITY. The commission shall expand the Medicaid program to cover families with a family income at or below 100 percent of the federal poverty level.

SECTION 2.06. WAITING LISTS FOR COMMUNITY-BASED MEDICAID WAIVER PROGRAMS. In offering services through community-based Medicaid waiver programs, the commission shall make services available to applicants in the order the applications are received, but shall progressively reduce the period during which an applicant must wait for services. Not later than September 1, 2017, the commission shall ensure that no eligible applicant waits more than 24 months to receive services from a community-based Medicaid waiver program.

SECTION 2.07. MEDICAID PROVIDERS. (a) The commission shall establish Medicaid provider reimbursement rates that achieve parity with similar rates paid under Medicare.

(b) The commission shall cooperate with Medicaid providers to facilitate the establishment of a medical home for Medicaid recipients that promotes the provision of timely and appropriate care.

SECTION 2.08. MEDICAL PASSPORT. The commission shall develop a medical passport for each Medicaid recipient. The commission shall determine the format of the passport. The passport may be maintained in an electronic format. The medical passport must include the most complete medical history of the recipient available and must be readily accessible to the recipient, the person authorized to consent to medical care for the recipient, and any provider of health care to the recipient.

ARTICLE 3. STATE CHILD HEALTH PLAN PROGRAM

SECTION 3.01. CHILD HEALTH PLAN ENROLLMENT AND RENEWAL. (a) The commission shall ensure that all children who are eligible for the state child health plan are enrolled in that plan.

(b) The commission shall establish a 12-month period of continuous eligibility for the state child health plan.

SECTION 3.02. CHILD HEALTH PLAN OUTREACH AND EDUCATION. (a) The commission shall establish a broad outreach campaign to educate families about the availability of affordable coverage for health care for their children, including the state child health plan, and the importance of coverage for health care in ensuring their children get the preventive and primary care services they need.

(b) The commission shall establish and promote an outreach program under which:

(1) emergency department personnel distribute applications for coverage under the state child health plan when uninsured children are treated in the emergency department;

(2) public schools provide information about the state child health plan at the beginning of the school year in connection with enrollment in programs for free or reduced price lunches; and

(3) information about the state child health plan is made available to parents who are applying for public assistance programs such as food stamps.

SECTION 3.03. ELIGIBILITY FOR CHILD HEALTH PLAN. In determining the eligibility of a child for enrollment in the state child health plan, the commission shall reduce the family income offsets for expenses such as child-care and work-related expenses, in accordance with standards applicable under the Medicaid program. The commission may not establish eligibility standards regarding the amount and types of allowable assets for a family.

SECTION 3.04. WAITING PERIOD. The commission may not impose a waiting period for enrollment in the state child health plan.

SECTION 3.05. EXPANSION OF COVERAGE UNDER CHILD HEALTH PLAN. (a) The commission shall establish a program under which a child who is eligible for the state child health plan, except that the child's family income exceeds the income eligibility requirements, may be enrolled in the plan. To be eligible for enrollment under the program, the child must demonstrate that the coverage is unavailable for the child because:

(1) the child's parents are self-employed; or

(2) the child's parents' employer or employers do not offer coverage for health care for dependent children of employees.

(b) The commission shall require premium payments for each child enrolled under Subsection (a) of this section on a sliding scale. The full monthly premium cost, including the amount of any federal or state share of that cost, must be paid for a child enrolled in the program whose family income is above 400 percent of the federal poverty level.

SECTION 3.06. MEDICAL HOME. The commission shall cooperate with health care providers to facilitate the establishment of a medical home for children enrolled in the state child health plan that promotes the provision of timely and appropriate care.

SECTION 3.07. MEDICAL PASSPORT. The commission shall develop a medical passport for each child enrolled in the state child health plan. The commission shall determine the format of the passport. The passport may be maintained in an electronic format. The medical passport must include the most complete medical history of the child available and must be readily accessible to the person authorized to consent to medical care for the child and any provider of health care to the child.

ARTICLE 4. PRIVATE SECTOR INITIATIVES

SECTION 4.01. EMPLOYER CREDITS. (a) The comptroller by rule shall implement credits under this section that an employer may apply against any amount owed to the state by the employer under state law. An employer may apply a credit under this section against:

(1) any tax imposed on the employer by state law, including the franchise tax, that raises general revenue for the state; and

(2) other fees, taxes, or charges imposed on the employer under state law and payable to the state or an agency of the state.

(b) A credit under this section shall be provided in relation to each of the employer's eligible employees who is enrolled in a plan that is offered by the employer and that provides coverage for health care. An employer is not eligible for credits under this section unless the employer provides that coverage for employees who work at least 20 hours. The amount of the credit is equal to the amount of the cost to the employer to provide the coverage.

(c) The comptroller shall allow the full amount of the credit in relation to each enrolled employee who has a family income at or below 200 percent of the federal poverty level and shall allow a pro rata reduced credit in relation to each enrolled employee who has a family income above 200 percent, but at or below 300 percent, of the federal poverty level.

(d) An employer is eligible for a credit under this section in any year in which the employer provides coverage for health care described by Subsection (b) of this section, provided that during the 12-month period before the date the employer first offers the coverage the employer did not offer coverage for health care to any of the employer's employees.

(e) An employer may transfer a credit earned in accordance with this section to another person in accordance with rules adopted by the comptroller.

SECTION 4.02. PUBLIC-PRIVATE PARTNERSHIPS. The commission shall provide grants to provide technical assistance and funding for planning and infrastructure development to encourage partnerships for coverage or benefits for health care among local governmental entities, state governmental entities, employers, philanthropic organizations, and employees.

SECTION 4.03. SMALL EMPLOYER REINSURANCE PROGRAM. The commissioner of insurance shall study the reinsurance system applicable to small employer health benefit plans under this state's law in relation to similar reinsurance systems operating in other states, including Arizona and New York. The commissioner of insurance shall by rule implement a reinsurance system, applicable to small employer health benefit plans, that is designed to promote the availability and affordability of small employer health benefit plan coverage.

SECTION 4.04. TEXAS HEALTH INSURANCE RISK POOL. (a) The board of directors of the Texas Health Insurance Risk Pool shall provide coverage through the pool to an individual who is eligible for coverage in accordance with Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.) (COBRA) if the individual can demonstrate that coverage offered through the pool:

(1) is more affordable than the COBRA coverage available to the individual; or

(2) offers better coverage than the COBRA coverage available to the individual.

(b) The board of directors of the Texas Health Insurance Risk Pool shall provide coverage through the pool to an individual who is covered under a multiple employer welfare arrangement as defined by Section 3, Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002), or an analogous benefit arrangement, to the extent that lifetime benefit limits imposed under the arrangement provide incomplete or inadequate coverage for the individual. Coverage provided through the pool under this subsection may be secondary to coverage provided to the individual under the multiple employer welfare arrangement or other analogous arrangement.

SECTION 4.05. STUDENTS IN INSTITUTIONS OF HIGHER EDUCATION. (a) The Texas Higher Education Coordinating Board shall require each student enrolled in a public institution of higher education in this state to have coverage for health care.

(b) The coverage for health care required by this section shall be provided in conjunction with enrollment in the institution, be paid for in the same manner that tuition and other fees are paid, and is an expense that a student may pay with student loans, scholarships, and other applicable grants.

SECTION 4.06. FEDERALLY QUALIFIED HEALTH CENTERS. The commission shall establish a fund to:

(1) support existing and new federally qualified community health centers; and

(2) maximize direct federal funding for these centers in this state.

SECTION 4.07. CONSOLIDATION OF MEDICAL AND DENTAL LOAN PROGRAMS. (a) The Texas Higher Education Coordinating Board shall administer each program of this state that offers medical, dental, and health care education loan forgiveness. A program described by this section in existence on the effective date of this Act is transferred to the board. The board shall administer the program to encourage more medical, dental, and health care providers to practice in underserved areas, in accordance with the law applicable to the program and this section.

(b) The Texas Higher Education Coordinating Board shall promote the availability of the programs subject to this section.

ARTICLE 5. EFFECTIVE DATE

SECTION 5.01. EFFECTIVE DATE. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2007.