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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. Subsection (b), Section 154.182, Family Code, is |
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amended to 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 the laws of this state. |
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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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(5) "Third-party administrator" means a person who is |
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not a health benefit plan issuer or agent of a health benefit plan |
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issuer and who provides administrative services for the program, |
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including processing enrollment of eligible children in the program |
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and processing premium payments on behalf of the program. |
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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 under Section |
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154.182(b)(1) or under Section 154.182(b)(2) from a source other |
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than the program. |
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(c) The director of the Title IV-D agency may establish an |
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advisory committee to consult with the director regarding the |
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implementation and operation of the program. If the director |
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establishes an advisory committee, the director may appoint any of |
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the following persons to the advisory committee: |
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(1) representatives of appropriate public and private |
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entities, including state agencies concerned with health care |
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management; |
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(2) members of the judiciary; |
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(3) members of the legislature; and |
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(4) representatives of the insurance industry. |
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(d) The principal objective of the program is to provide |
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basic health care services, including office visits with health |
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care providers, hospitalization, and diagnostic and emergency |
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services, to eligible children in Title IV-D cases at reasonable |
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cost to the parents obligated by court order to provide medical |
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support for the children. |
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(e) The Title IV-D agency may use available private |
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resources, including gifts and grants, in administering the |
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program. |
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(f) 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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Texas Department of Insurance and the Health and Human Services |
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Commission in establishing policies and procedures for the |
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administration of the program and in determining appropriate |
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benefits to be provided under the program. |
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(g) A health benefit plan issuer that participates in the |
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program may not deny health care coverage under the program to |
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eligible children because of preexisting conditions or chronic |
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illnesses. A child who is determined to be eligible for coverage |
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under the program continues to be eligible until the termination of |
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the parent's duty to pay child support as specified by Section |
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154.006. Enrollment of a child in the program does not preclude the |
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subsequent enrollment of the child in another health care plan that |
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becomes available to the child's parent at reasonable cost, |
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including a health care plan available through the parent's |
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employment or the state child health plan under Chapter 62, Health |
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and Safety Code. |
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(h) The Title IV-D agency shall contract with an independent |
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third-party administrator to provide necessary administrative |
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services for operation of the program. |
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(i) A person acting as a third-party administrator under |
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Subsection (h) is not considered an administrator for purposes of |
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Chapter 4151, Insurance Code. |
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(j) The Title IV-D agency shall solicit applications for |
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participation in the program from health benefit plan issuers that |
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meet requirements specified by the agency. Each health benefit |
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plan issuer that participates in the program must hold a |
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certificate of authority issued by the Texas Department of |
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Insurance. |
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(k) 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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(l) On or after the date specified in the notification |
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required by Subsection (k), 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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health insurance is available for the child at reasonable cost, |
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including the state child health plan under Chapter 62, Health and |
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Safety Code. |
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(m) Payment of premium costs for the enrollment of a child |
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in the program may be enforced by the Title IV-D agency against the |
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obligor by any means available for the enforcement of a child |
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support obligation, including income withholding under Chapter |
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158. |
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(n) The program is not subject to any provision of the |
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Insurance Code or other law that requires coverage or the offer of |
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coverage of a health care service or benefit. |
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(o) Any health information obtained by the program, or by a |
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third-party administrator providing program services, that is |
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subject to the Health Insurance Portability and Accountability Act |
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of 1996 (42 U.S.C. Section 1320d et seq.) or Chapter 181, Health and |
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Safety Code, is confidential and not open to public inspection. Any |
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personally identifiable financial information or supporting |
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documentation of a parent whose child is enrolled in the program |
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that is obtained by the program, or by a third-party administrator |
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providing program services, is confidential and not open to public |
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inspection. |
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Sec. 154.1827. ADMINISTRATIVE ADJUSTMENT OF MEDICAL |
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SUPPORT ORDER. (a) In each Title IV-D case in which a medical |
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support order requires that a child be enrolled in a health care |
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program under Section 154.1826, the Title IV-D agency may |
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administratively adjust the order as necessary on an annual basis |
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to reflect changes in the amount of premium costs associated with |
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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 of this Act takes effect September 1, 2009. |
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