By: Watson, Ellis  S.B. No. 922
         (In the Senate - Filed February 26, 2007; March 7, 2007,
  read first time and referred to Committee on State Affairs;
  May 3, 2007, reported adversely, with favorable Committee
  Substitute by the following vote:  Yeas 9, Nays 0; May 3, 2007,
  sent to printer.)
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 922 By:  Lucio
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to regional or local health care programs for employees of
  small employers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  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.  Subject to Section 75.153, 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.
         (b)  A governing body may apply for and receive funding from
  the health opportunity pool under Subchapter D.
         (b-1)  A governing body may apply for and receive a grant
  under Subchapter E to support a regional or local health care
  program.  This subsection expires September 1, 2009.
         (c)  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 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.
         (c)  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.  TEXAS HEALTH OPPORTUNITY POOL
         Sec. 75.151.  DEFINITION.  In this subchapter, "health
  opportunity pool" means the pooled fund of state money and federal
  money established and used in accordance with a waiver under
  Section 1115 of the federal Social Security Act (42 U.S.C. Section
  1315) to the state Medicaid plan.
         Sec. 75.152.  FUNDING AUTHORIZED.  Notwithstanding any other
  law, a regional or local health care program may apply for funding
  from the health opportunity pool and the pool may provide funding in
  accordance with this subchapter.
         Sec. 75.153.  ELIGIBILITY FOR POOL FUNDS; STATEWIDE
  ELIGIBILITY CRITERIA.  To be eligible for funding from money in the
  health opportunity pool that is provided subject to a federal
  waiver, a regional or local health care program must comply with any
  requirement imposed under the waiver, including, to the extent
  applicable, any requirement that health care benefits or services
  provided under the program be provided in accordance with statewide
  eligibility criteria.
  [Sections 75.154-75.200 reserved for expansion]
  SUBCHAPTER E.  GRANTS FOR DEMONSTRATION PROJECTS
         Sec. 75.201.  DEFINITIONS.  In this subchapter:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Executive commissioner" means the executive
  commissioner of the commission.
         Sec. 75.202.  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.  If the executive commissioner establishes a
  grant program under this subchapter, the executive commissioner
  must select at least one grant recipient operating a regional
  health care program to receive a grant.
         (c)  The commission shall establish performance objectives
  for a grant recipient and shall monitor the performance of the grant
  recipient.
         Sec. 75.203.  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. 75.204.  EXPIRATION.  This subchapter expires September
  1, 2009.
         SECTION 2.  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
         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.
 
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