By: Zerwas H.B. No. 3791

A BILL TO BE ENTITLED

AN ACT

rel ating to the creation of a "Texas" solution to issues related to Medicaid, including flexibility in the administration of the Medicaid program, tailored to the needs of the state.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. The legislature finds that:

a) Our current Texas Medicaid program has reached an unsustainable capacity;

b) Texas stands to gain coverage for a significant number of now uninsured residents through any healthcare expansion; and

c) The current Texas network of hospital and physician providers cannot endure an expansion of patient need without significant reform;

d) It is in the best interest of this state that the Legislature and the Texas Health and Human Services Commission negotiate a plan that considers the particular needs of Texas, our economy, and unique population.

SECTION 2. Subchapter B, Chapter 531, Government Code, is amended by adding Section 531.02105 to read as follows:

Sec. 531.02105. FLEXIBILITY FROM FEDERAL REQUIREMENTS. (a) The commission shall negotiate with the United States secretary of health and human services, the federal Centers for Medicare and Medicaid Services, and other appropriate persons for flexibility to adjust the operation of the Medicaid program without the necessity of receiving federal approval for all changes to the program. Any agreement reached must identify broad categories of:

(1) program changes that may be made without the need for additional federal approval; and

(2) program changes that require additional federal approval;

(b) In reaching an agreement, the commission shall ensure that any agreement:

(1) allows the state flexibility from federal requirements to develop a tailor insurance product for low-income adults;

(2) allows any product to leverage private markets by building on a managed care model and maximizing premium assistance where cost effective to the state;

(3) allow the product to prioritize personal responsibility by meaningful cost sharing requirements;

(4) benefits Texas taxpayers by providing appropriate health care coverage, encourages appropriate health care utilization in low-cost settings, provides meaningful tax relief at the local level, and frees up general revenue to support other state priorities.

(c) An agreement under this section may be limited in duration and may be contingent on the continued funding obligations of the federal government.

SECTION 3. Subtitle I, Title 4, Government Code, is amended by adding Chapter 539 to read as follows:

CHAPTER 539. ALTERNATIVE MEDICAID EXPANSION PROGRAMS

Sec. 539.001. FEDERAL AUTHORIZATION FOR ALTERNATIVE MEDICAID EXPANSION PROGRAMS. In addition to the commission's ability to negotiate under Section 531,02105, The commission shall actively negotiate with the United States secretary of health and human services, the federal Centers for Medicare and Medicaid Services, and other appropriate persons for federal authorization for the state to operate the component of the state Medicaid program for providing program benefits to the Medicaid expansion population under an alternative Medicaid expansion plan, including a block grant funding system or state plan amendment.

Sec. 539.002. MINIMUM REQUIREMENTS OF FEDERAL AUTHORIZATION. Federal authorization obtained under Section 539.001 must allow for providing state Medicaid program benefits to recipients in the Medicaid expansion population under the same terms and conditions as an agreement under Section 531.02105

Sec. 539.003. IMPLEMENTATION OF ALTERNATIVE MEDICAID EXPANSION PLAN. If the commission receives the authorization described by Section 539.002, the commission shall develop and provide any appropriate state Medicaid program.

SECTION 4. The Health and Human Services Commission shall actively develop a proposal for the authorization from the appropriate federal entity as required by Section 531.02105 and Chapter 539, Government Code, as added by this Act. As soon as possible after the effective date of this Act, the Health and Human Services Commission shall request and actively pursue obtaining the authorization from the appropriate federal entity.

SECTION 5. (a) The Health and Human Services Commission, the Texas Department of Insurance, or the commission in conjunction with the department, shall negotiate with the appropriate federal entity for authorization to develop any appropriate alternative Medicaid expansion plan, including a state health benefit exchange. The negotiated authorization must allow the state health benefit exchange to be flexible, patient-friendly, tailored to the needs of the state, and be similar to the health benefit exchange described in the Patients' Choice Act, S.B. 516, 111th Congress (2009), or H.R. 2520, 111th Congress (2009).

(b) If the appropriate federal entity authorizes an alternative Medicaid expansion plan, including a state health benefit exchange described in Subsection (a) of this section, the Health and Human Services Commission, the Texas Department of Insurance, or the commission in conjunction with the department, shall develop and implement the health benefit exchange.

SECTION 6. Not later than September 1, 2013, the Speaker of the House and the Lieutenant Governor shall each appoint a chair and four additional members of their respective houses to advise the Health and Human Services Commission and the Texas Department of Insurance on negotiations with the federal government regarding federal authorization for the state to operate the component of the state Medicaid program for providing program benefits to the Medicaid expansion population under an alternative Medicaid expansion plan, including a block grant funding system or state plan amendment.

SECTION 7. This Act takes effect immediately if it 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, this Act takes effect September 1, 2013.