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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage for health care for Texans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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ARTICLE 1. GENERAL PROVISIONS |
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SECTION 1.01. FINDINGS. (a) The growing ranks of uninsured |
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Texans pose a critical threat to the physical health of all Texans, |
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as well as the state's economy. The lack of coverage for health care |
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contributes to a sicker, less productive population and to a higher |
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tax burden for businesses, home owners, and individuals. |
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(b) Texas has the highest percentage of uninsured |
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individuals in the nation. One in four Texans, 5.6 million people, |
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lack coverage for health care. Seventy-nine percent of uninsured |
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adult Texans are part of the workforce or have a family member in |
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the workforce, while 1.4 million children, 21 percent of the |
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population, lack coverage for health care. |
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(c) Texas workers are less likely to have employment-based |
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coverage for health care than workers in other states. Only 55 |
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percent of Texans have access to employer-sponsored coverage for |
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health care, while only 37 percent of Texans who work in the small |
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businesses that make up the majority of Texas employers have access |
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to employer-sponsored coverage for health care. |
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(d) While Medicaid and the state child health plan are |
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cost-effective programs to help working parents provide health |
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insurance for their children, an estimated 700,000 children are |
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eligible for Medicaid and the state child health plan but are not |
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enrolled. Given the generous federal matching dollars, Medicaid and |
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the state child health plan are cost-effective ways for the state to |
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help working parents provide health care coverage for their |
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children. |
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(e) The state Medicaid program pays physicians the lowest |
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reimbursement among all payers. While Medicaid enrollment has |
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increased, only 38 percent of Texas physicians accept new Medicaid |
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patients, forcing these patients to rely on expensive, already |
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overcrowded emergency rooms for their care. |
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(f) For Texas to compete economically at home and abroad, |
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the state must invest in a healthy population and workforce, which |
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includes ensuring that all Texans can obtain affordable, timely |
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health care. |
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SECTION 1.02. PURPOSE. The purpose of this Act is to |
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implement commonsense, cost-effective strategies to ensure that |
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Texas families and businesses have access to affordable health |
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care. |
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SECTION 1.03. DEFINITION. In this Act, "commission" means |
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the Health and Human Services Commission. |
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SECTION 1.04. RULES; IMPLEMENTATION. Notwithstanding any |
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other law, the executive commissioner of the commission, the |
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comptroller, the commissioner of insurance, the board of directors |
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of the Texas Health Insurance Risk Pool, and the Texas Higher |
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Education Coordinating Board shall by rule implement the |
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requirements of this Act. |
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ARTICLE 2. MEDICAID |
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SECTION 2.01. MEDICAID ENROLLMENT AND RENEWAL. (a) The |
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commission shall ensure that all children who are eligible for the |
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Medicaid program are enrolled in that program. |
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(b) The commission shall establish a 12-month period of |
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continuous eligibility for the Medicaid program. |
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SECTION 2.02. MEDICAID OUTREACH AND EDUCATION. (a) The |
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commission shall establish a broad outreach campaign to educate |
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families about the availability of affordable coverage for health |
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care for their children, including Medicaid, and the importance of |
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coverage for health care in ensuring their children get the |
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preventive and primary care services they need. |
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(b) The commission shall establish and promote an outreach |
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program under which: |
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(1) emergency department personnel distribute |
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Medicaid applications when uninsured children are treated in the |
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emergency department; |
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(2) public schools provide information about Medicaid |
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at the beginning of the school year in connection with enrollment in |
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programs for free or reduced price lunches; and |
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(3) information about Medicaid is made available to |
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parents who are applying for public assistance programs such as |
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food stamps. |
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SECTION 2.03. MEDICAID HEALTH INSURANCE PREMIUM PROGRAM. |
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The commission shall expand the Medicaid health insurance premium |
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program to use Medicaid funds to subsidize private coverage for |
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health care for working individuals who would otherwise qualify for |
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Medicaid so that more Medicaid eligible workers who have access to, |
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but cannot afford, employer-sponsored coverage may acquire and |
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retain this coverage. |
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SECTION 2.04. ADULT MEDICALLY NEEDY PROGRAM. The commission |
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shall reestablish the medically needy program that serves pregnant |
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women, children, and caretakers who have high medical expenses. At |
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a minimum, the program must serve recipients, including adult |
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recipients, in the same manner and at the same level that services |
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were provided to recipients under the medically needy program |
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during the state fiscal biennium ending August 31, 2003. |
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SECTION 2.05. EXPAND MEDICAID ELIGIBILITY. The commission |
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shall expand the Medicaid program to cover families with a family |
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income at or below 100 percent of the federal poverty level. |
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SECTION 2.06. WAITING LISTS FOR COMMUNITY-BASED MEDICAID |
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WAIVER PROGRAMS. In offering services through community-based |
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Medicaid waiver programs, the commission shall make services |
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available to applicants in the order the applications are received, |
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but shall progressively reduce the period during which an applicant |
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must wait for services. Not later than September 1, 2017, the |
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commission shall ensure that no eligible applicant waits more than |
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24 months to receive services from a community-based Medicaid |
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waiver program. |
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SECTION 2.07. MEDICAID PROVIDERS. (a) The commission shall |
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establish Medicaid provider reimbursement rates that achieve |
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parity with similar rates paid under Medicare. |
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(b) The commission shall cooperate with Medicaid providers |
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to facilitate the establishment of a medical home for Medicaid |
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recipients that promotes the provision of timely and appropriate |
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care. |
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SECTION 2.08. MEDICAL PASSPORT. The commission shall |
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develop a medical passport for each Medicaid recipient. The |
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commission shall determine the format of the passport. The |
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passport may be maintained in an electronic format. The medical |
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passport must include the most complete medical history of the |
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recipient available and must be readily accessible to the |
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recipient, the person authorized to consent to medical care for the |
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recipient, and any provider of health care to the recipient. |
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ARTICLE 3. STATE CHILD HEALTH PLAN PROGRAM |
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SECTION 3.01. CHILD HEALTH PLAN ENROLLMENT AND RENEWAL. (a) |
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The commission shall ensure that all children who are eligible for |
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the state child health plan are enrolled in that plan. |
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(b) The commission shall establish a 12-month period of |
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continuous eligibility for the state child health plan. |
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SECTION 3.02. CHILD HEALTH PLAN OUTREACH AND EDUCATION. |
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(a) The commission shall establish a broad outreach campaign to |
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educate families about the availability of affordable coverage for |
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health care for their children, including the state child health |
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plan, and the importance of coverage for health care in ensuring |
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their children get the preventive and primary care services they |
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need. |
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(b) The commission shall establish and promote an outreach |
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program under which: |
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(1) emergency department personnel distribute |
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applications for coverage under the state child health plan when |
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uninsured children are treated in the emergency department; |
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(2) public schools provide information about the state |
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child health plan at the beginning of the school year in connection |
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with enrollment in programs for free or reduced price lunches; and |
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(3) information about the state child health plan is |
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made available to parents who are applying for public assistance |
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programs such as food stamps. |
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SECTION 3.03. ELIGIBILITY FOR CHILD HEALTH PLAN. In |
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determining the eligibility of a child for enrollment in the state |
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child health plan, the commission shall reduce the family income |
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offsets for expenses such as child-care and work-related expenses, |
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in accordance with standards applicable under the Medicaid |
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program. The commission may not establish eligibility standards |
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regarding the amount and types of allowable assets for a family. |
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SECTION 3.04. WAITING PERIOD. The commission may not impose |
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a waiting period for enrollment in the state child health plan. |
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SECTION 3.05. EXPANSION OF COVERAGE UNDER CHILD HEALTH |
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PLAN. (a) The commission shall establish a program under which a |
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child who is eligible for the state child health plan, except that |
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the child's family income exceeds the income eligibility |
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requirements, may be enrolled in the plan. To be eligible for |
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enrollment under the program, the child must demonstrate that the |
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coverage is unavailable for the child because: |
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(1) the child's parents are self-employed; or |
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(2) the child's parents' employer or employers do not |
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offer coverage for health care for dependent children of employees. |
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(b) The commission shall require premium payments for each |
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child enrolled under Subsection (a) of this section on a sliding |
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scale. The full monthly premium cost, including the amount of any |
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federal or state share of that cost, must be paid for a child |
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enrolled in the program whose family income is above 400 percent of |
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the federal poverty level. |
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SECTION 3.06. MEDICAL HOME. The commission shall cooperate |
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with health care providers to facilitate the establishment of a |
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medical home for children enrolled in the state child health plan |
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that promotes the provision of timely and appropriate care. |
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SECTION 3.07. MEDICAL PASSPORT. The commission shall |
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develop a medical passport for each child enrolled in the state |
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child health plan. The commission shall determine the format of the |
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passport. The passport may be maintained in an electronic format. |
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The medical passport must include the most complete medical history |
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of the child available and must be readily accessible to the person |
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authorized to consent to medical care for the child and any provider |
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of health care to the child. |
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ARTICLE 4. PRIVATE SECTOR INITIATIVES |
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SECTION 4.01. EMPLOYER CREDITS. (a) The comptroller by rule |
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shall implement credits under this section that an employer may |
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apply against any amount owed to the state by the employer under |
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state law. An employer may apply a credit under this section |
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against: |
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(1) any tax imposed on the employer by state law, |
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including the franchise tax, that raises general revenue for the |
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state; and |
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(2) other fees, taxes, or charges imposed on the |
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employer under state law and payable to the state or an agency of |
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the state. |
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(b) A credit under this section shall be provided in |
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relation to each of the employer's eligible employees who is |
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enrolled in a plan that is offered by the employer and that provides |
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coverage for health care. An employer is not eligible for credits |
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under this section unless the employer provides that coverage for |
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employees who work at least 20 hours. The amount of the credit is |
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equal to the amount of the cost to the employer to provide the |
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coverage. |
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(c) The comptroller shall allow the full amount of the |
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credit in relation to each enrolled employee who has a family income |
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at or below 200 percent of the federal poverty level and shall allow |
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a pro rata reduced credit in relation to each enrolled employee who |
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has a family income above 200 percent, but at or below 300 percent, |
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of the federal poverty level. |
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(d) An employer is eligible for a credit under this section |
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in any year in which the employer provides coverage for health care |
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described by Subsection (b) of this section, provided that during |
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the 12-month period before the date the employer first offers the |
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coverage the employer did not offer coverage for health care to any |
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of the employer's employees. |
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(e) An employer may transfer a credit earned in accordance |
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with this section to another person in accordance with rules |
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adopted by the comptroller. |
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SECTION 4.02. PUBLIC-PRIVATE PARTNERSHIPS. The commission |
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shall provide grants to provide technical assistance and funding |
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for planning and infrastructure development to encourage |
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partnerships for coverage or benefits for health care among local |
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governmental entities, state governmental entities, employers, |
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philanthropic organizations, and employees. |
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SECTION 4.03. SMALL EMPLOYER REINSURANCE PROGRAM. The |
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commissioner of insurance shall study the reinsurance system |
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applicable to small employer health benefit plans under this |
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state's law in relation to similar reinsurance systems operating in |
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other states, including Arizona and New York. The commissioner of |
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insurance shall by rule implement a reinsurance system, applicable |
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to small employer health benefit plans, that is designed to promote |
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the availability and affordability of small employer health benefit |
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plan coverage. |
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SECTION 4.04. TEXAS HEALTH INSURANCE RISK POOL. (a) The |
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board of directors of the Texas Health Insurance Risk Pool shall |
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provide coverage through the pool to an individual who is eligible |
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for coverage in accordance with Title X, Consolidated Omnibus |
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Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.) |
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(COBRA) if the individual can demonstrate that coverage offered |
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through the pool: |
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(1) is more affordable than the COBRA coverage |
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available to the individual; or |
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(2) offers better coverage than the COBRA coverage |
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available to the individual. |
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(b) The board of directors of the Texas Health Insurance |
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Risk Pool shall provide coverage through the pool to an individual |
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who is covered under a multiple employer welfare arrangement as |
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defined by Section 3, Employee Retirement Income Security Act of |
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1974 (29 U.S.C. Section 1002), or an analogous benefit arrangement, |
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to the extent that lifetime benefit limits imposed under the |
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arrangement provide incomplete or inadequate coverage for the |
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individual. Coverage provided through the pool under this |
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subsection may be secondary to coverage provided to the individual |
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under the multiple employer welfare arrangement or other analogous |
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arrangement. |
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SECTION 4.05. STUDENTS IN INSTITUTIONS OF HIGHER EDUCATION. |
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(a) The Texas Higher Education Coordinating Board shall require |
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each student enrolled in a public institution of higher education |
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in this state to have coverage for health care. |
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(b) The coverage for health care required by this section |
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shall be provided in conjunction with enrollment in the |
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institution, be paid for in the same manner that tuition and other |
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fees are paid, and is an expense that a student may pay with student |
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loans, scholarships, and other applicable grants. |
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SECTION 4.06. FEDERALLY QUALIFIED HEALTH CENTERS. The |
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commission shall establish a fund to: |
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(1) support existing and new federally qualified |
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community health centers; and |
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(2) maximize direct federal funding for these centers |
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in this state. |
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SECTION 4.07. CONSOLIDATION OF MEDICAL AND DENTAL LOAN |
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PROGRAMS. (a) The Texas Higher Education Coordinating Board shall |
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administer each program of this state that offers medical, dental, |
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and health care education loan forgiveness. A program described by |
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this section in existence on the effective date of this Act is |
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transferred to the board. The board shall administer the program to |
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encourage more medical, dental, and health care providers to |
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practice in underserved areas, in accordance with the law |
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applicable to the program and this section. |
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(b) The Texas Higher Education Coordinating Board shall |
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promote the availability of the programs subject to this section. |
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ARTICLE 5. EFFECTIVE DATE |
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SECTION 5.01. EFFECTIVE DATE. This Act takes effect |
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immediately if it receives a vote of two-thirds of all the members |
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elected to each house, as provided by Section 39, Article III, Texas |
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Constitution. If this Act does not receive the vote necessary for |
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immediate effect, this Act takes effect September 1, 2007. |