80R9929 ABC-D

By: Miles H.B. No. 3121

A BILL TO BE ENTITLED

AN ACT

relating to health coverage or health services for Texans.

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

SECTION 1. The Health and Safety Code is amended by adding Title 13 to read as follows: TITLE 13. HEALTH COVERAGE OR HEALTH SERVICES SUBTITLE A. GENERAL PROVISIONS CHAPTER 2001. DEFINITIONS

Sec. 2001.001. GENERAL DEFINITIONS. In this title:

(1) "Commission" means the Health and Human Services Commission.

(2) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission. [Chapters 2002-2100 reserved for expansion] SUBTITLE B. DUTIES OF EMPLOYERS CHAPTER 2101. EMPLOYER CONTRIBUTIONS

Sec. 2101.001. DEFINITIONS. In this chapter:

(1) "Large employer" means a person who employed an average of at least 100 eligible employees on business days during the preceding calendar year.

(2) "Medium-sized employer" means a person who employed an average of at least 20 but not more than 99 eligible employees on business days during the preceding calendar year.

Sec. 2101.002. DETERMINATION OF EMPLOYER STATUS. For an employer that did not exist throughout the calendar year preceding the year in which the determination of whether the employer is a large or medium-sized employer is made, the determination is based on the average number of employees and eligible employees the employer reasonably expects to employ on business days in the calendar year in which the determination is made.

Sec. 2101.003. BASIC HEALTH CARE RATE EXPENDITURE DETERMINED. The comptroller shall compute the basic health care expenditure rate for each state fiscal year. The rate is equal to the average monthly amount paid by the Teacher Retirement System of Texas during the preceding state fiscal year for coverage for a covered employee under the primary care coverage plan offered under Chapter 1579, Insurance Code, divided by 172.

Sec. 2101.004. COMPUTATION OF EMPLOYEE HOURS; LIMIT. In this chapter, "employee hour" means each hour for which an employee is entitled to payment from an employer, whether the payment is made on an hourly basis or as salary, and including amounts paid for vacation, sick leave, and personal leave. Notwithstanding the number of hours actually worked, the maximum monthly number of employee hours for which a contribution must be made under this chapter for an employee is 172.

Sec. 2101.005. REQUIRED EMPLOYER CONTRIBUTION. Each large or medium-sized employer in this state shall contribute the amount required by this chapter for health coverage or health services for the employer's employees.

Sec. 2101.006. AMOUNT OF REQUIRED CONTRIBUTION. (a) A large employer shall contribute for each month an amount equal to 75 percent of the basic health care expenditure rate multiplied by the employer's total number of employee hours for that month. The contribution under this subsection may not be less than $1.60 for each employee hour.

(b) A medium-sized employer shall contribute for each month an amount equal to 50 percent of the basic health care expenditure rate multiplied by the employer's total number of employee hours for that month. The contribution under this subsection may not be less than $1.06 for each employee hour.

Sec. 2101.007. MANNER OF MAKING CONTRIBUTION; HEALTH COVERAGE OR STATE CONTRIBUTION. A large or medium-sized employer may make the contribution required by this chapter by:

(1) expending the amount of the contribution to provide health coverage to the employer's employees through any plan or program that meets the requirements established by the executive commissioner, including any type of coverage that is creditable coverage for purposes of Chapter 1205, Insurance Code; or

(2) contributing to the Texas Health Access Program established under Subtitle C. CHAPTER 2102. ADMINISTRATION BY COMPTROLLER

Sec. 2102.001. REPORTING REQUIREMENTS. The comptroller by rule shall establish reporting requirements to verify compliance with Section 2101.007.

Sec. 2102.002. COLLECTION OF CONTRIBUTIONS. The comptroller shall collect contributions made under Section 2101.007 and may by rule establish applicable deadlines and procedures for collecting the contributions. Subtitles A and B, Title 2, Tax Code, apply to the administration, collection, and enforcement by the comptroller of contributions collected under this section.

Sec. 2102.003. COOPERATION OF OTHER AGENCIES. In adopting rules under this chapter, the comptroller may consult with any agency of this state, including the Texas Workforce Commission. [Chapters 2103-2200 reserved for expansion] SUBTITLE C. TEXAS HEALTH ACCESS PROGRAM CHAPTER 2201. ADMINISTRATION OF PROGRAM

Sec. 2201.001. DEFINITIONS. In this title:

(1) "Fund" means the Texas Health Access Program fund.

(2) "Program" means the Texas Health Access Program.

Sec. 2201.002. ADMINISTRATION BY COMMISSION; RULEMAKING. (a) The commission administers the program.

(b) The executive commissioner may adopt rules in accordance with Subchapter B, Chapter 2001, Government Code, as necessary or appropriate for the administration of the program.

Sec. 2201.003. ELIGIBILITY. (a) A resident of this state is eligible to receive health care services through the program if the person is a resident of this state and is not covered under health coverage that satisfies the requirements of Section 2101.007(1). The executive commissioner by rule may establish additional eligibility requirements but may not require that an individual be employed to be eligible for enrollment in the program.

(b) The executive commissioner by rule may establish procedures for verifying eligibility for enrollment in the program.

Sec. 2201.004. ENROLLMENT. The executive commissioner by rule shall establish procedures for application and enrollment for the program.

Sec. 2201.005. ENROLLEE CONTRIBUTION. An eligible resident enrolled in the program shall pay a monthly contribution as required by the executive commissioner by rule.

Sec. 2201.006. EVIDENCE OF COVERAGE. The commission may issue a card or other evidence of coverage to be used by an eligible resident to show proof that the resident is enrolled in the program. CHAPTER 2202. HEALTH CARE PROVIDERS

Sec. 2202.001. DEFINITIONS. In this chapter:

(1) "Health care facility" means a public or private hospital, emergency clinic, outpatient clinic, or other facility providing health care services. The term includes a community-based facility and a facility operated by a hospital district or another political subdivision of this state.

(2) "Health care practitioner" means an individual who is licensed to provide health care services. The term includes a physician.

(3) "Health care provider" means a health care facility or health care practitioner.

Sec. 2202.002. NETWORK OF HEALTH CARE PROVIDERS. The executive commissioner shall contract with health care providers to provide services to eligible residents enrolled in the program.

Sec. 2202.003. CREDENTIALING. The executive commissioner may establish standards for participation in the program as a health care provider to ensure the quality of the health care services provided and the level of service provided.

Sec. 2202.004. PAYMENT RATES. The executive commissioner may establish payment rates for participating health care providers. CHAPTER 2203. HEALTH CARE SERVICES

Sec. 2203.001. HEALTH CARE SERVICES PROVIDED DIRECTLY; NOT INSURANCE. (a) The program provides health care services directly to enrollees through contracted health care providers and is not liable to reimburse the cost of services that are provided to enrollees by health care providers that have not contracted with the program.

(b) The program is not insurance and does not provide coverage as a health maintenance organization. The program is not subject to regulation under the Insurance Code.

Sec. 2203.002. SCOPE OF HEALTH CARE SERVICES PROVIDED. The program provides health care services that the executive commissioner determines are reasonably needed to maintain good health and that are medically necessary for the enrollee.

Sec. 2203.003. MEDICAL HOME. The program must provide health care services through a primary care model, in which a physician, nurse practitioner, or physician assistant develops and directs a plan of care for the enrollee, coordinates referrals for medical testing and specialty services, and monitors the management of chronic conditions and diseases. CHAPTER 2204. TEXAS HEALTH ACCESS PROGRAM FUND

Sec. 2204.001. FUND. (a) The Texas Health Access Program fund is a fund in the state treasury. The fund is composed of:

(1) contributions of employers made to the fund under Section 2101.007;

(2) contributions of enrollees to the fund under Section 2201.005;

(3) federal money allocated to the fund in accordance with law;

(4) state contributions to the fund; and

(5) the earnings of the fund.

(b) The comptroller shall administer the fund in accordance with this title.

Sec. 2204.002. APPLICATION FOR FEDERAL FUNDING. The executive commissioner, through application for an appropriate waiver from the Centers for Medicare and Medicaid Services or another appropriate funding source, shall seek federal funding for the operation of the program.

Sec. 2204.003. USE OF FUND. Money in the fund may be used only to pay for contracted health care services under the program and to administer the program in accordance with this chapter.

SECTION 2. The Health and Human Services Commission shall implement the Texas Health Access Program not later than January 1, 2010. An employer is not required to make a contribution under Section 2101.007, Health and Safety Code, as added by this Act, for an employee hour that occurs before January 1, 2010.

SECTION 3. 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.