81R5962 KLA-D

By: Marquez H.B. No. 2200

A BILL TO BE ENTITLED

AN ACT

relating to eligibility for and administration of the child health plan program.

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

SECTION 1. Sections 62.002(2) and (4), Health and Safety Code, are amended to read as follows:

(2) "Executive commissioner" or "commissioner [Commissioner]" means the executive commissioner of the Health [health] and Human Services Commission [human services].

(4) "Net family income" means the 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 program.

SECTION 2. Section 62.101(b), Health and Safety Code, is amended 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 family income is at or below 300 [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 net family income is above 150 percent of the federal poverty level.]

SECTION 3. Section 62.102(a), Health and Safety Code, is amended to read as follows:

(a) The [Subject to a review under Subsection (b), 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, beginning the first day of the month following the date of the eligibility determination; or

(2) the individual's 19th birthday.

SECTION 4. Section 62.151(b), Health and Safety Code, is amended to read as follows:

(b) In developing the covered benefits, the commission shall consider the health care needs of healthy children and children with special health care needs. The child health plan must provide at least the covered benefits described by the recommended benefits package described for a state-designed child health plan by the Texas House of Representatives Committee on Public Health "CHIP" Interim Report to the Seventy-Sixth Texas Legislature dated December 1998 and the Senate Interim Committee on Children's Health Insurance Report to the Seventy-Sixth Texas Legislature dated December 1, 1998. The child health plan must include at least the covered benefits provided under the plan on June 1, 2003.

SECTION 5. Section 62.153(b), Health and Safety Code, is amended to read as follows:

(b) Cost-sharing [Subject to Subsection (d), cost-sharing] provisions adopted under this section shall ensure that families with higher levels of income are required to pay progressively higher percentages of the cost of the plan.

SECTION 6. Sections 62.155(c) and (d), Health and Safety Code, are amended to read as follows:

(c) In selecting a health plan provider, the commission:

(1) may give preference to a person who provides similar coverage under the Medicaid program; and

(2) shall provide for a choice of at least two health plan providers in each metropolitan [service] area.

(d) The commissioner may authorize an exception to Subsection (c)(2) if there is only one acceptable applicant to become a health plan provider in the metropolitan [service] area.

SECTION 7. Chapter 62, Health and Safety Code, is amended by adding Subchapter F to read as follows:

SUBCHAPTER F. BUY-IN OPTION

Sec. 62.251. BUY-IN OPTION FOR CERTAIN CHILDREN. The executive commissioner shall develop and implement a buy-in option in accordance with this subchapter under which children whose net family incomes exceed 300 percent of the federal poverty level, but do not exceed 400 percent of the federal poverty level, are eligible to purchase health benefits coverage available under the child health plan program.

Sec. 62.252. RULES; ELIGIBILITY AND COST-SHARING. (a) The executive commissioner shall adopt rules in accordance with federal law that apply to a child for whom health benefits coverage is purchased under this subchapter. The rules must:

(1) establish eligibility requirements;

(2) require payment of 100 percent of health benefits plan premiums, fees to offset administrative costs incurred under this subchapter, and additional deductibles, coinsurance, or other cost-sharing payments as determined by the executive commissioner; and

(3) provide for a waiting period comparable to the waiting period required under Section 62.154(d).

(b) Notwithstanding any other provision of this chapter, the executive commissioner may establish rules and procedures for children for whom health benefits coverage is purchased under this subchapter that differ from the rules and procedures generally applicable to the child health plan program.

Sec. 62.253. CROWD-OUT. To the extent allowed by federal law, the buy-in option developed under this subchapter must include provisions designed to discourage:

(1) employers and other persons from electing to discontinue offering health benefits plan coverage for employees' children under employee or other group health benefits plans; and

(2) individuals with access to adequate health benefits plan coverage for their children through an employer-sponsored group health benefits plan, as determined by the executive commissioner, from electing not to obtain, or to discontinue, that coverage.

SECTION 8. Sections 62.101(b-1), 62.102(b) and (c), 62.151(f), and 62.153(d), Health and Safety Code, are repealed.

SECTION 9. Not later than November 1, 2010, the executive commissioner of the Health and Human Services Commission shall adopt rules as necessary to implement Subchapter F, Chapter 62, Health and Safety Code, as added by this Act.

SECTION 10. 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 11. This Act takes effect September 1, 2009.