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A BILL TO BE ENTITLED
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AN ACT
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relating to eligibility for and administration of the child health |
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plan program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 62.002(2) and (4), Health and Safety |
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Code, are amended to read as follows: |
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(2) "Executive commissioner" or "commissioner |
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[Commissioner]" means the executive commissioner of the Health |
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[health] and Human Services Commission [human services]. |
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(4) "Net family income" means the amount of income |
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established for a family after reduction for offsets for expenses |
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such as child care and work-related expenses, in accordance with |
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standards applicable under the Medicaid program. |
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SECTION 2. Section 62.101(b), Health and Safety Code, is |
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amended to read as follows: |
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(b) The commission shall establish income eligibility |
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levels consistent with Title XXI, Social Security Act (42 U.S.C. |
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Section 1397aa et seq.), as amended, and any other applicable law or |
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regulations, and subject to the availability of appropriated money, |
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so that a child who is younger than 19 years of age and whose net |
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family income is at or below 300 [200] percent of the federal |
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poverty level is eligible for health benefits coverage under the |
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program. [In addition, the commission may establish eligibility
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standards regarding the amount and types of allowable assets for a
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family whose net family income is above 150 percent of the federal
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poverty level.] |
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SECTION 3. Section 62.102(a), Health and Safety Code, is |
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amended to read as follows: |
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(a) The [Subject to a review under Subsection (b), the] |
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commission shall provide that an individual who is determined to be |
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eligible for coverage under the child health plan remains eligible |
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for those benefits until the earlier of: |
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(1) the end of a period not to exceed 12 months, |
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beginning the first day of the month following the date of the |
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eligibility determination; or |
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(2) the individual's 19th birthday. |
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SECTION 4. Section 62.151(b), Health and Safety Code, is |
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amended to read as follows: |
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(b) In developing the covered benefits, the commission |
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shall consider the health care needs of healthy children and |
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children with special health care needs. The child health plan must |
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provide at least the covered benefits described by the recommended |
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benefits package described for a state-designed child health plan |
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by the Texas House of Representatives Committee on Public Health |
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"CHIP" Interim Report to the Seventy-Sixth Texas Legislature dated |
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December 1998 and the Senate Interim Committee on Children's Health |
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Insurance Report to the Seventy-Sixth Texas Legislature dated |
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December 1, 1998. The child health plan must include at least the |
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covered benefits provided under the plan on June 1, 2003. |
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SECTION 5. Section 62.153(b), Health and Safety Code, is |
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amended to read as follows: |
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(b) Cost-sharing [Subject to Subsection (d), cost-sharing] |
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provisions adopted under this section shall ensure that families |
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with higher levels of income are required to pay progressively |
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higher percentages of the cost of the plan. |
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SECTION 6. Sections 62.155(c) and (d), Health and Safety |
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Code, are amended to read as follows: |
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(c) In selecting a health plan provider, the commission: |
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(1) may give preference to a person who provides |
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similar coverage under the Medicaid program; and |
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(2) shall provide for a choice of at least two health |
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plan providers in each metropolitan [service] area. |
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(d) The commissioner may authorize an exception to |
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Subsection (c)(2) if there is only one acceptable applicant to |
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become a health plan provider in the metropolitan [service] area. |
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SECTION 7. Chapter 62, Health and Safety Code, is amended by |
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adding Subchapter E to read as follows: |
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SUBCHAPTER E. BUY-IN OPTION |
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Sec. 62.201. BUY-IN OPTION FOR CERTAIN CHILDREN. The |
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executive commissioner shall develop and implement a buy-in option |
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in accordance with this subchapter under which children whose net |
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family incomes exceed 300 percent of the federal poverty level, but |
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do not exceed 400 percent of the federal poverty level, are eligible |
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to purchase health benefits coverage available under the child |
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health plan program. |
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Sec. 62.202. RULES; ELIGIBILITY AND COST-SHARING. (a) The |
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executive commissioner shall adopt rules in accordance with federal |
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law that apply to a child for whom health benefits coverage is |
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purchased under this subchapter. The rules must: |
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(1) establish eligibility requirements; |
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(2) require payment of 100 percent of health benefits |
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plan premiums, fees to offset administrative costs incurred under |
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this subchapter, and additional deductibles, coinsurance, or other |
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cost-sharing payments as determined by the executive commissioner; |
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and |
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(3) provide for a waiting period comparable to the |
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waiting period required under Section 62.154(d). |
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(b) Notwithstanding any other provision of this chapter, |
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the executive commissioner may establish rules and procedures for |
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children for whom health benefits coverage is purchased under this |
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subchapter that differ from the rules and procedures generally |
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applicable to the child health plan program. |
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Sec. 62.203. CROWD-OUT. To the extent allowed by federal |
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law, the buy-in option developed under this subchapter must include |
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provisions designed to discourage: |
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(1) employers and other persons from electing to |
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discontinue offering health benefits plan coverage for employees' |
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children under employee or other group health benefits plans; and |
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(2) individuals with access to adequate health |
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benefits plan coverage for their children through an |
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employer-sponsored group health benefits plan, as determined by the |
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executive commissioner, from electing not to obtain, or to |
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discontinue, that coverage. |
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SECTION 8. Sections 62.101(b-1), 62.102(b) and (c), |
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62.151(f), and 62.153(d), Health and Safety Code, are repealed. |
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SECTION 9. Not later than November 1, 2012, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt rules as necessary to implement Subchapter E, Chapter 62, |
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Health and Safety Code, as added by this Act. |
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SECTION 10. If before implementing any provision of this |
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Act a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 11. This Act takes effect September 1, 2011. |