80R1337 JTS/KLA-D
 
  By: Uresti S.B. No. 693
 
 
 
   
 
 
A BILL TO BE ENTITLED
AN ACT
relating to eligibility for and administration of certain health
benefits programs.
       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
       SECTION 1.  Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0631 to read as follows:
       Sec. 531.0631.  MEDICAID AND CHIP ELIGIBILITY AND ENROLLMENT
SYSTEM PERFORMANCE LEVELS. The commission shall ensure that the
processing time for applications and eligibility redeterminations
for the Medicaid program and the child health plan program meet or
exceed the performance levels met in state fiscal year 2004 by
ensuring that:
             (1)  the private and public components, including call
centers, of the eligibility and enrollment systems for the Medicaid
program and the child health plan program are adequately staffed
and trained; and
             (2)  all computer systems that support the eligibility
and enrollment systems are performing properly.
       SECTION 2.  Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.093 and 531.094 to read as follows:
       Sec. 531.093.  PROVIDER PAYMENT RATES UNDER MEDICAID AND
CHIP. (a)  For the Medicaid and child health plan programs, the
commission shall:
             (1)  establish provider payment rates that are at or
above the level established during the state fiscal biennium
beginning September 1, 2002;
             (2)  apply annual inflation increases to provider
payment rates; and
             (3)  enact a plan to bring provider payment rates to
Medicare levels.
       (b)  To the extent of a conflict between the requirements of
Section 531.021 or any other law and the requirements of this
section with respect to the adoption of rates for the Medicaid
program, the requirements of this section prevail.
       Sec. 531.094.  COMMUNITY OUTREACH AND EDUCATION CAMPAIGN FOR
HEALTH PLANS FOR CHILDREN. (a) The commission shall conduct a
community outreach and education campaign to provide information
relating to the availability of health benefits for children under
the child health plan and Medicaid programs. 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 and education campaign must:
             (1)  educate families about:
                   (A)  available coverage for children;
                   (B)  the importance of keeping their children
enrolled; and
                   (C)  how to effectively and appropriately use
health care services, including providing families in the child
health plan program with clear directions on how to track their
total cost-sharing to ensure they are not charged more than their
out-of-pocket caps;
             (2)  expand the role of community-based organizations
in outreach and education;
             (3)  invite and support partnership by schools,
businesses, churches, and other community institutions willing to
contribute to the effort to enroll eligible children in health care
programs;
             (4)  address the need for special outreach in rural
areas and to families with preschool-aged children; and
             (5)  include a statewide marketing program promoting
child health programs.
       (c)  The community outreach and education campaign must be at
least as extensive as the community outreach and education campaign
in effect during the fiscal year beginning September 1, 2002, with a
goal of reaching two million adults each year.
       SECTION 3.  Section 62.002(4), 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 4.  Section 62.101, Health and Safety Code, is
amended by amending Subsection (b) and adding Subsection (d) 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.]
       (d)  As authorized by 42 U.S.C. Section 1397gg, the executive
commissioner of the Health and Human Services Commission shall
adopt rules providing for the determination and certification of
the presumptive eligibility of a child for the child health plan
program who applies and meets the basic eligibility requirements
for that program.  Rules adopted under this subsection may not apply
to a child to whom a waiting period applies under Section 62.154.
       SECTION 5.  Section 62.102, Health and Safety Code, is
amended to read as follows:
       Sec. 62.102.  CONTINUOUS COVERAGE.  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, [the
six-month period] following the date of the eligibility
determination; or
             (2)  the individual's 19th birthday.
       SECTION 6.  Section 62.103(d), Health and Safety Code, is
amended to read as follows:
       (d)  The commission may permit application to be made by
mail, over the telephone, or through the Internet, using an online
application through the Texas Integrated Enrollment Services
eligibility determination system.
       SECTION 7.  Section 62.153, Health and Safety Code, is
amended by adding Subsection (e) to read as follows:
       (e)  If cost-sharing provisions imposed under Subsection (a)
include an enrollment fee, the executive commissioner of the Health
and Human Services Commission by rule shall establish methods of
fee payment that are feasible and convenient for a participant who
does not have a bank account. The methods may include:
             (1)  installment plans;
             (2)  the ability to make cash payments at local grocery
store and retail sites; and
             (3)  payment by debit or credit card.
       SECTION 8.  Sections 62.154(a) and (d), 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.
       (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 only 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.  Section 32.026, Human Resources Code, is amended
by adding Subsection (h) to read as follows:
       (h)  As authorized by 42 U.S.C. Section 1396r-1a, the
executive commissioner of the Health and Human Services Commission
shall adopt rules providing for the determination and certification
of the presumptive eligibility for medical assistance of a child
under 19 years of age who applies and meets the basic eligibility
requirements for that assistance.
       SECTION 10.  Section 32.0261, Human Resources Code, is
amended to read as follows:
       Sec. 32.0261.  CONTINUOUS ELIGIBILITY.  The department shall
adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as
amended, to provide for a period of continuous eligibility for a
child under 19 years of age who is determined to be eligible for
medical assistance under this chapter. The rules shall provide
that the child remains eligible for medical assistance, without
additional review by the department and regardless of changes in
the child's resources or income, until the earlier of:
             (1)  the end of a period, not to exceed 12 months, [the
six-month period] following the date on which the child's
eligibility was determined; or
             (2)  the child's 19th birthday.
       SECTION 11.  Section 32.064, Human Resources Code, is
amended by adding Subsection (e) to read as follows:
       (e)  If cost-sharing provisions imposed under Subsection (a)
include an enrollment fee, the executive commissioner of the Health
and Human Services Commission by rule shall establish methods of
fee payment that are feasible and convenient for a recipient who
does not have a bank account. The methods may include:
             (1)  installment plans;
             (2)  the ability to make cash payments at local grocery
store and retail sites; and
             (3)  payment by debit or credit card.
       SECTION 12.  The Health and Human Services Commission shall
conduct a study to assess possible methods for ensuring that health
benefits coverage is available to every child in this state at a
cost commensurate with the child's household income. Not later
than December 1, 2009, the commission shall submit a report to the
legislature detailing the commission's findings and making
recommendations based on those findings.
       SECTION 13.  If before implementing any provision of this
Act a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
       SECTION 14.  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.