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