82R3060 KLA-D
 
  By: Marquez H.B. No. 2474
 
 
 
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 E to read as follows:
  SUBCHAPTER E. BUY-IN OPTION
         Sec. 62.201.  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. 62.202.  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. 62.203.  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, 2012, the executive
  commissioner of the Health and Human Services Commission shall
  adopt rules as necessary to implement Subchapter E, 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, 2011.