81R10350 KLA-D

By: Coleman H.B. No. 2962

A BILL TO BE ENTITLED

AN ACT

relating to eligibility for and administration of the child health plan and Medicaid 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 531.02417 to read as follows:

Sec. 531.02417. ENROLLMENT AND RETENTION MODIFICATIONS FOR RECEIPT OF FEDERAL BONUS PAYMENTS. (a) Notwithstanding any other provision of this chapter, Chapter 62, Health and Safety Code, Chapter 32, Human Resources Code, or any other law, the commission shall take all necessary actions to modify enrollment and retention processes employed in the child health plan and Medicaid programs to ensure that this state receives federal performance bonus payments made available under Section 2105(a)(3), Social Security Act (42 U.S.C. Section 1397ee(a)(3)), or, if an enrollment and retention process employed in those programs does not require a modification, maintain the process to ensure receipt of those payments.

(b) Actions the commission is required to take under Subsection (a) include implementing or maintaining the following with respect to children younger than 19 years of age:

(1) a 12-month period of continuous eligibility for the child health plan and Medicaid programs, as required by Section 62.102, Health and Safety Code, and Section 32.0261, Human Resources Code, respectively;

(2) liberalizing asset test requirements for eligibility determinations for the child health plan and Medicaid programs, which may include:

(A) eliminating the asset test regardless of whether the test is specifically authorized by statute; or

(B) permitting an applicant, or the applicant's parent or guardian, to certify under penalty of perjury information relating to assets or using an asset verification process that does not require an applicant, or the applicant's parent or guardian, to provide documentation except when discrepancies are discovered or under other circumstances that justify requiring documentation, as determined by the executive commissioner in accordance with federal law;

(3) eliminating any personal interview requirements for determining eligibility for the child health plan or Medicaid programs, notwithstanding any other law;

(4) using the same application, set of supplemental forms, if applicable, and information verification process for determining eligibility for the child health plan and Medicaid programs; and

(5) using automatic, administrative processes for recertifying eligibility for the child health plan and Medicaid programs that comply with the requirements specified by Section 2105(a)(4)(E), Social Security Act (42 U.S.C. Section 1397ee(a)(4)(E)), including:

(A) providing a preprinted form completed by the commission or a person contracting with the commission to perform eligibility and enrollment functions that is based on available information, unless other information is provided or obtained through verification; and

(B) using an ex parte process under which no personal interview is required unless the commission, or the person contracting with the commission to perform eligibility and enrollment functions, does not have sufficient information to recertify eligibility and that information cannot be acquired from other sources without the participation of an applicant or the applicant's parent or guardian.

SECTION 2. 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 3. 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 4. 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 5. 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 6. 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 7. 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 8. 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 9. 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 first anniversary of [end of the six-month period following] the date on which the child's eligibility was determined; or

(2) the child's 19th birthday.

SECTION 10. Sections 62.101(b-1), 62.102(b) and (c), 62.151(f), and 62.153(d), Health and Safety Code, are repealed.

SECTION 11. Not later than November 1, 2009, 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 12. The changes in law made by this Act apply to an initial determination of eligibility or a recertification of eligibility for the child health plan program under Chapter 62, Health and Safety Code, or the medical assistance program under Chapter 32, Human Resources Code, made on or after September 1, 2009.

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, 2009.