82R4254 SJM-F
 
  By: Rodriguez S.B. No. 611
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to 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 child care
  expenses and child support payments, in accordance with standards
  applicable under the Medicaid program.
         SECTION 2.  Sections 62.101(b) and (b-1), Health and Safety
  Code, are 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 250 [150] percent of the
  federal poverty level.
         (b-1)  The eligibility standards adopted under Subsection
  (b) related to allowable assets:
               (1)  must allow a family to own at least $20,000
  [$10,000] in allowable assets; and
               (2)  may not in calculating the amount of allowable
  assets under Subdivision (1) consider:
                     (A)  the value of one vehicle that qualifies for
  an exemption under commission rule based on its use;
                     (B)  the value of a second or subsequent vehicle
  that qualifies for an exemption under commission rule based on its
  use if:
                           (i)  the vehicle is worth $18,000 or less; or
                           (ii)  the vehicle has been modified to
  provide transportation for a household member with a disability;
                     (C)  if no vehicle qualifies for an exemption
  based on its use under commission rule, the [first $18,000 of] value
  of the highest valued vehicle; or
                     (D)  the first $7,500 of value of any vehicle not
  described by Paragraph (A), (B), or (C).
         SECTION 3.  Subchapter C, Chapter 62, Health and Safety
  Code, is amended by adding Section 62.1012 to read as follows:
         Sec. 62.1012.  EXCLUSION OF COLLEGE SAVINGS PLANS. For
  purposes of determining whether a child meets family income and
  resource requirements for eligibility for the child health plan,
  the commission may not consider as income or resources a right to
  assets held in or a right to receive payments or benefits under any
  of the following:
               (1)  any fund or plan established under Subchapter F or
  H, Chapter 54, Education Code, including an interest in a prepaid
  tuition contract;
               (2)  any fund or plan established under Subchapter G,
  Chapter 54, Education Code, including an interest in a savings
  trust account;
               (3)  any qualified tuition program of any state that
  meets the requirements of Section 529, Internal Revenue Code of
  1986; or
               (4)  any taxable credit-only savings account that is
  opened in a child's name and gifted to the child by a postsecondary
  education awards program and that is exclusively accessible by the
  program administrator.
         SECTION 4.  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 5.  Section 62.153, Health and Safety Code, is
  amended by amending Subsections (a) and (c) and adding Subsections
  (a-1) and (a-2) to read as follows:
         (a)  To the extent permitted under 42 U.S.C. Section 1397cc,
  as amended, and any other applicable law or regulations, the
  commission shall require enrollees whose net family incomes are at
  or below 200 percent of the federal poverty level to share the cost
  of the child health plan, including provisions requiring enrollees
  under the child health plan to pay:
               (1)  a copayment for services provided under the plan;
               (2)  an enrollment fee; or
               (3)  a portion of the plan premium.
         (a-1)  The commission shall require enrollees whose net
  family incomes are greater than 200 percent but not greater than 300
  percent of the federal poverty level to pay a share of the cost of
  the child health plan through copayments, fees, and a portion of the
  plan premium. The total amount of the share required to be paid
  must:
               (1)  include a portion of the plan premium set at an
  amount determined by the commission that is approximately equal to
  2.5 percent of an enrollee's net family income;
               (2)  exceed the amount required to be paid by enrollees
  described by Subsection (a), but the total amount required to be
  paid may not exceed five percent of an enrollee's net family income;
  and
               (3)  increase incrementally, as determined by the
  commission, as an enrollee's net family income increases.
         (a-2)  In establishing the cost required to be paid by an
  enrollee described by Subsection (a-1) as a portion of the plan
  premium, the commission shall ensure that the cost progressively
  increases as the number of children in the enrollee's family
  provided coverage increases.
         (c)  The [If cost-sharing provisions imposed under
  Subsection (a) include requirements that enrollees pay a portion of
  the plan premium, the] commission shall specify the manner of
  payment for any portion of the plan premium required to be paid by
  an enrollee under this section [in which the premium is paid]. The
  commission may require that the premium be paid to the [Texas
  Department of] Health and Human Services Commission, the [Texas]
  Department of State Health [Human] Services, or the health plan
  provider. The commission shall develop an option for an enrollee to
  pay monthly premiums using direct debits to bank accounts or credit
  cards.
         SECTION 6.  Section 62.154, Health and Safety Code, is
  amended by amending Subsection (d) and adding Subsection (e) to
  read as follows:
         (d)  The waiting period required by Subsection (a) for a
  child whose net family income is at or below 200 percent of the
  federal poverty level must:
               (1)  extend for a period of 90 days after the last date
  on which the applicant was covered under a health benefits plan; and
               (2)  apply to a child who was covered by a health
  benefits plan at any time during the 90 days before the date of
  application for coverage under the child health plan.
         (e)  The waiting period required by Subsection (a) for a
  child whose net family income is greater than 200 percent but not
  greater than 300 percent of the federal poverty level must:
               (1)  extend for a period of 180 days after the last date
  on which the applicant was covered under a health benefits plan; and
               (2)  apply to a child who was covered by a health
  benefits plan at any time during the 180 days before the date of
  application for coverage under the child health plan.
         SECTION 7.  Subchapter D, Chapter 62, Health and Safety
  Code, is amended by adding Section 62.1551 to read as follows:
         Sec. 62.1551.  TERMINATION OF COVERAGE FOR NONPAYMENT OF
  PREMIUMS.  (a)  The executive commissioner by rule shall establish a
  process that allows for the termination of coverage under the child
  health plan of an enrollee whose net family income is greater than
  200 percent but not greater than 300 percent of the federal poverty
  level if the enrollee does not pay the premiums required under
  Section 62.153(a-1).
         (b)  The rules required by Subsection (a) must:
               (1)  address the number of payments that may be missed
  before coverage terminates;
               (2)  address the process for notifying an enrollee of
  pending coverage termination; and
               (3)  provide for an appropriate lock-out period after
  termination for nonpayment.
         SECTION 8.  Subchapter D, Chapter 62, Health and Safety
  Code, is amended by adding Section 62.160 to read as follows:
         Sec. 62.160.  PROSPECTIVE PAYMENT SYSTEM FOR CERTAIN
  SERVICES. (a)  In this section:
               (1)  "Federally-qualified health center" has the
  meaning assigned by Section 1905(l)(2)(B), Social Security Act (42
  U.S.C. Section 1396d(l)(2)(B)).
               (2)  "Federally-qualified health center services" has
  the meaning assigned by Section 1905(l)(2)(A), Social Security Act
  (42 U.S.C. Section 1396d(l)(2)(A)).
               (3)  "Rural health clinic" and "rural health clinic
  services" have the meanings assigned by Section 1905(l)(1), Social
  Security Act (42 U.S.C. Section 1396d(l)(1)).
         (b)  The commission shall apply the prospective payment
  system established under Section 1902(bb), Social Security Act (42
  U.S.C. Section 1396a(bb)), in providing child health plan coverage
  for rural health clinic services provided through rural health
  clinics and federally-qualified health center services provided
  through federally-qualified health centers in accordance with
  Section 2107(e)(1), Social Security Act (42 U.S.C. Section
  1397gg(e)(1)).
         SECTION 9.  Chapter 62, Health and Safety Code, is amended by
  adding Subchapter F to read as follows:
  SUBCHAPTER F. BUY-IN OPTION
         Sec. 62.251.  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, but do not exceed 400 percent, of
  the federal poverty level are eligible to purchase health benefits
  coverage similar to coverage available under the child health plan
  program.
         Sec. 62.252.  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, including a
  requirement that a child must lack access to adequate health
  benefits plan coverage through an employer-sponsored group health
  benefits plan;
               (2)  ensure that premiums:
                     (A)  are set at a level designed to cover the costs
  of coverage for children participating in the buy-in option under
  this subchapter; and
                     (B)  progressively increase as the number of
  children in the enrollee's family provided coverage increases;
               (3)  ensure that required premiums and costs for the
  coverage for a child under this subchapter:
                     (A)  are at least equal to the cost to the
  commission of otherwise providing child health plan coverage,
  including dental benefits, to another child who is the same age, and
  who resides in the same state service delivery area, as the child
  receiving coverage under this subchapter; and
                     (B)  include:
                           (i)  a fee in an amount determined by the
  commission to offset all or part of the cost of prescription drugs
  provided to enrollees under this subchapter;
                           (ii)  fees to offset administrative costs
  incurred under this subchapter; and
                           (iii)  additional deductibles, coinsurance,
  or other cost-sharing payments as determined by the executive
  commissioner; and
               (4)  include an option for an enrollee to pay monthly
  premiums using direct debits to bank accounts or credit cards.
         (a-1)  The rules adopted under Subsection (a)(1) must
  provide that a child is eligible for health benefits coverage under
  this subchapter only if the child was eligible for the medical
  assistance program under Chapter 32, Human Resources Code, or the
  child health plan program under Section 62.101 and was enrolled in
  the applicable program, but the child's enrollment was not renewed
  because, at the time of the eligibility redetermination, the
  child's net family income exceeded the limit specified by Section
  62.101.
         (b)  Notwithstanding any other provision of this chapter,
  the executive commissioner may establish rules, benefit coverage,
  and procedures for children for whom health benefits coverage is
  purchased under this subchapter that differ from the rules, benefit
  coverage, and procedures generally applicable to the child health
  plan program.
         Sec. 62.253.  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.
         Sec. 62.254.  POINT-OF-SERVICE COPAYMENT. The commission
  shall establish point-of-service copayments for the buy-in option
  developed under this subchapter that are higher than
  point-of-service copayments required for a child whose net family
  income is at or below 300 percent of the federal poverty level.
         Sec. 62.255.  LOCK-OUT.  (a)  In this section, "lock-out
  period" means a period after coverage is terminated for nonpayment
  of premiums, during which a child may not be reenrolled in the child
  health plan program.
         (b)  The commission shall include a lock-out period for the
  buy-in option developed under this subchapter for the purpose of
  providing a disincentive for a parent to drop a child's coverage
  when a child is healthy and reenroll only when health care needs
  occur.
         SECTION 10.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.0992 to read as follows:
         Sec. 531.0992.  COMMUNITY OUTREACH FOR THE CHILD HEALTH PLAN
  PROGRAM.  (a)  The commission shall improve the effectiveness of
  community outreach efforts with respect to the child health plan
  program, including efforts conducted under Section 62.056, Health
  and Safety Code. To improve that effectiveness, the commission
  shall:
               (1)  increase the capacity of existing outreach efforts
  implemented through community-based organizations by providing
  those organizations with adequate resources to:
                     (A)  educate the public about the child health
  plan program;
                     (B)  provide assistance to the public in
  completing applications for eligibility or recertification of
  eligibility and obtaining required documentation for applications;
  and
                     (C)  assist applicants in resolving problems
  encountered during the eligibility determination process;
               (2)  establish a partnership with stakeholders who will
  provide outreach and application assistance by:
                     (A)  fostering the exchange of information
  regarding, and promoting, best practices for obtaining health
  benefits coverage for children;
                     (B)  assisting the commission in designing and
  implementing processes to reduce procedural denials; and
                     (C)  disseminating successful outreach models
  across this state under which entities such as hospitals, school
  districts, and local businesses partner to identify children
  without health benefits coverage; and
               (3)  focus the outreach efforts particularly on
  enrolling eligible persons in the child health plan program.
         (b)  The partnership established under Subsection (a)(2)
  must include entities that contract with the commission to perform
  child health plan program eligibility determination and enrollment
  functions, community-based organizations that contract with the
  commission, health benefit plan providers, Texas Health Steps
  program contractors, health care providers, consumer advocates,
  and other interested stakeholders.
         (c)  The commission may also improve the effectiveness of
  community outreach efforts with respect to the child health plan
  program by contracting with one or more persons to provide outreach
  and application assistance for the program. The commission shall
  require each potential contractor under this subsection to indicate
  the person's interest in writing before submitting a proposal for a
  contract. If more than one person from a geographic area determined
  by the commission submits a letter of interest, the commission
  shall encourage the persons from that area to collaborate on a
  proposal for a contract.
         (d)  To the extent practicable, the commission shall give
  preference in awarding contracts under Subsection (c) to proposals
  submitted by collaborations that include multiple entities with
  experience in serving a variety of populations, including
  populations that more commonly enroll in or receive benefits under
  the child health plan program.
         SECTION 11.  Chapter 531, Government Code, is amended by
  adding Subchapter M-1 to read as follows:
  SUBCHAPTER M-1. CHILD HEALTH PLAN PROGRAM ELIGIBILITY
  DETERMINATION STREAMLINING AND IMPROVEMENT
         Sec. 531.471.  DEFINITIONS. In this subchapter:
               (1)  "SAVERR" means the System of Application,
  Verification, Eligibility, Referral, and Reporting.
               (2)  "TIERS" means the Texas Integrated Eligibility
  Redesign System.
         Sec. 531.472.  CORRECTIVE ACTION PLAN. If for three
  consecutive months less than 90 percent of the applications or
  eligibility recertifications for the child health plan program are
  accurately processed through SAVERR, TIERS, or otherwise, within
  the applicable processing time requirements established by state
  and federal law, the executive commissioner by rule shall adopt a
  corrective action plan for the child health plan program that:
               (1)  identifies the steps necessary to improve the
  timeliness of application processing and the accuracy of
  eligibility determinations; and
               (2)  to the extent possible within the staffing levels
  authorized by the General Appropriations Act, ensures that child
  health plan program eligibility determinations are accurately made
  within applicable processing time requirements established by
  state and federal law.
         Sec. 531.473.  REDUCTION OF DENIALS FOR MISSING INFORMATION.
  (a) The executive commissioner by rule shall adopt processes
  designed to reduce denials of eligibility for the child health plan
  program due to information missing from an application. The
  processes must include providing comprehensive information to an
  applicant or enrollee regarding acceptable documentation of income
  for purposes of an eligibility determination.
         (b)  Before imposing a denial of eligibility for the child
  health plan program for failure to provide information needed to
  complete an application, including an application for
  recertification, the commission shall:
               (1)  attempt to contact the applicant or enrollee by
  telephone or mail to describe the specific information that must be
  provided to complete the application; and
               (2)  allow the person a period of at least 10 business
  days to provide the missing information instead of requiring the
  person to submit a new application.
         Sec. 531.474.  CALL RESOLUTION STANDARDS. The executive
  commissioner shall establish telephone call resolution standards
  and processes for each call center established under Section
  531.063, including a call center operated by a contractor, to
  ensure that telephone calls regarding questions, issues, or
  complaints received at call centers regarding the child health plan
  program are accurately handled by call center staff and are
  successfully resolved by call center or agency staff.
         SECTION 12.  Sections 62.102(b) and (c) and 62.151(f),
  Health and Safety Code, are repealed.
         SECTION 13.  Not later than January 1, 2012, the executive
  commissioner of the Health and Human Services Commission shall
  adopt rules as necessary to implement Subchapter F, Chapter 62,
  Health and Safety Code, as added by this Act.
         SECTION 14.  The changes in law made by this Act apply to an
  initial determination of eligibility or a recertification of
  eligibility for the child health plan program under Chapter 62,
  Health and Safety Code, made on or after September 1, 2011.
         SECTION 15.  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 16.  This Act takes effect September 1, 2011.