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A BILL TO BE ENTITLED
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AN ACT
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relating to health care coverage for children in Title IV-D cases. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 154.182(b), Family Code, is amended to |
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read as follows: |
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(b) In determining the manner in which health care coverage |
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for the child is to be ordered, the court shall render its order in |
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accordance with the following priorities, unless a party shows good |
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cause why a particular order would not be in the best interest of |
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the child: |
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(1) if health insurance is available for the child |
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through a parent's employment or membership in a union, trade |
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association, or other organization at reasonable cost [to the
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parent], the court shall order that parent to include the child in |
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the parent's health insurance; |
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(2) if health insurance is not available for the child |
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under Subdivision (1) but is available to a parent at reasonable |
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cost from another source, including the program under Section |
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154.1826 to provide health insurance in Title IV-D cases [and at a
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reasonable cost], the court may order that parent to provide health |
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insurance for the child; or |
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(3) if health insurance coverage is not available for |
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the child under Subdivision (1) or (2), the court shall order the |
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obligor to pay the obligee, in addition to any amount ordered under |
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the guidelines for child support, an amount, not to exceed nine |
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percent of the obligor's annual [monthly] resources, as described |
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by Section 154.062(b), as cash medical support for the child. |
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SECTION 2. Subchapter D, Chapter 154, Family Code, is |
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amended by adding Sections 154.1826 and 154.1827 to read as |
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follows: |
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Sec. 154.1826. HEALTH CARE PROGRAM FOR CERTAIN CHILDREN IN |
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TITLE IV-D CASES. (a) In this section: |
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(1) "Health benefit plan issuer" means an insurer, |
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health maintenance organization, or other entity authorized to |
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provide health benefits coverage under this section, including a |
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primary care case management provider network. |
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(2) "Health care provider" means a physician or other |
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person who is licensed, certified, or otherwise authorized to |
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provide a health care service in this state. |
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(3) "Program" means the child health care program |
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developed under this section. |
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(4) "Reasonable cost" has the meaning assigned by |
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Section 154.181(e). |
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(b) In consultation with the Texas Department of Insurance, |
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the Health and Human Services Commission, and representatives of |
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the insurance industry in this state, the Title IV-D agency shall |
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develop and implement a statewide program to address the health |
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care needs of children in Title IV-D cases for whom health insurance |
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is not available to either parent at reasonable cost in the manner |
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described by Section 154.182(b)(1). |
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(c) The principal objective of the program is to provide |
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basic health care services, including usual physician services, |
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office visits, hospitalization, and laboratory, x-ray, and |
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emergency services, to eligible children in Title IV-D cases at |
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reasonable cost to the parents obligated by court order to provide |
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medical support for the children. The health care services |
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provided are intended to be commensurate in range of services with |
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the premium reimbursement available to a health benefit plan |
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issuer. |
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(d) It is the intent of the legislature that the Title IV-D |
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agency maximize the use of private resources in administering the |
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program, including the use of gifts and grants. To the extent |
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federal money is available for that purpose, the Title IV-D agency |
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may contract with a third-party administrator to provide enrollment |
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and related services under the program. |
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(e) The Title IV-D agency shall adopt rules as necessary to |
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implement the program. The Title IV-D agency shall consult with the |
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Health and Human Services Commission and other public and private |
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health care authorities in establishing policies regarding |
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benefits provided by the program. |
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(f) The program may not deny health care coverage to |
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eligible children because of preexisting conditions or chronic |
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illnesses, and must provide a uniform schedule of benefits for all |
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children enrolled in the program. A child who is determined to be |
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eligible for coverage under the program continues to be eligible |
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until the termination of the parent's duty to pay child support as |
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specified by Section 154.006. |
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(g) The Title IV-D agency shall solicit applications for |
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participation in the program from health benefit plan issuers who |
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meet requirements specified by the agency. The Title IV-D agency |
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shall consult with the Texas Department of Insurance in the |
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appropriate rating of health benefit plan issuers who apply for |
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participation in the program. Each health benefit plan issuer who |
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participates in the program must hold a certificate of authority |
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issued by the Texas Department of Insurance. |
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(h) The Title IV-D agency shall promptly notify the courts |
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of this state when the program has been implemented and is available |
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to provide for the health care needs of children described by |
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Subsection (b). The notification must specify a date beginning on |
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which children may be enrolled in the program. |
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(i) On or after the date specified in the notification |
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required by Subsection (h), a court that orders health care |
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coverage for a child in a Title IV-D case shall order that the child |
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be enrolled in the program authorized by this section unless other |
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private health insurance is available for the child at reasonable |
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cost. |
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(j) Payment of premium costs for the enrollment of a child |
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in the program may be enforced against the obligor by any means |
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available for the enforcement of a child support obligation, |
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including income withholding under Chapter 158. |
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(k) To provide the flexibility necessary to provide |
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services at a reasonable cost to an obligor, and notwithstanding |
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any provision in the Insurance Code, the program authorized by this |
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section is not subject to a law that requires: |
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(1) coverage or the offer of coverage of a particular |
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health care service or benefit; |
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(2) coverage or the offer of coverage for the |
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provision of services by a particular health care provider, other |
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than a provider selected for participation in the program; or |
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(3) the use of a particular insurance policy or |
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contract form or of particular language in a policy or contract |
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form. |
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Sec. 154.1827. ADMINISTRATIVE ADJUSTMENT OF MEDICAL |
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SUPPORT ORDER. (a) In a Title IV-D case in which a medical support |
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order requires that a child be enrolled in a health care program |
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under Section 154.1826, the Title IV-D agency may administratively |
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adjust the order as necessary to reflect changes in the amount of |
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premium costs associated with the child's enrollment. |
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(b) The Title IV-D agency shall provide notice of the |
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administrative adjustment to the obligor and the clerk of the court |
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that rendered the order. |
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SECTION 3. This Act takes effect September 1, 2009, except |
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that Section 2 of this Act takes effect immediately if this Act |
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receives a vote of two-thirds of all the members elected to each |
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house, as provided by Section 39, Article III, Texas Constitution. |
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If this Act does not receive the vote necessary for immediate |
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effect, Section 2 takes effect September 1, 2009. |