By: Deuell S.B. No. 1477
 
 
 
   
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to flexibility in the administration of the Medicaid
  program, a block grant funding approach to Medicaid expansion, and
  the establishment of a health benefit exchange tailored to the
  needs of the state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02105 to read as follows:
         Sec. 531.02105.  FLEXIBILITY FROM FEDERAL REQUIREMENTS. 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.
         SECTION 2.  Subtitle I, Title 4, Government Code, is amended
  by adding Chapter 539 to read as follows:
  CHAPTER 539. BLOCK GRANT PROGRAM FOR MEDICAID EXPANSION POPULATION
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 539.001.  DEFINITIONS. In this chapter:
               (1)  "Health benefit exchange" means an American Health
  Benefit Exchange administered by the federal government, an
  exchange created pursuant to Section 1311(b) of the Patient
  Protection and Affordable Care Act (42 U.S.C. Section 18031(b)), or
  a federally-authorized alternative state exchange.
               (2)  "Medicaid expansion population" means the
  category of persons who would not be eligible for medical
  assistance under the eligibility criteria in effect on December 31,
  2013, but for whom federal matching funds are available under the
  Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
  amended by the Health Care Affordable Care Act of 2010 (Pub. L. No.
  111-152) to provide that assistance.
               (3)  "Medicaid program" means the medical assistance
  program established and operated under Title XIX of the federal
  Social Security Act (42 U.S.C. Section 1396 et seq.).
               (4)  "State Medicaid program" means the medical
  assistance program operated by this state as part of the Medicaid
  program.
         Sec. 539.002.  CONFLICT WITH OTHER LAW. To the extent of a
  conflict between a provision of this chapter and another state law,
  the provision of this chapter controls.
  SUBCHAPTER B. MEDICAID EXPANSION POPULATION PROGRAM REQUIREMENTS
         Sec. 539.051.  FEDERAL AUTHORIZATION FOR BLOCK GRANT SYSTEM.  
   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 a block grant funding system.
         Sec. 539.052.  MINIMUM REQUIREMENTS OF FEDERAL
  AUTHORIZATION. (a) Federal authorization obtained under Section
  539.051 must allow for providing state Medicaid program benefits to
  recipients in the Medicaid expansion population in the form of
  premium assistance so private health benefit coverage may be
  obtained through a health benefit exchange.
         (b)  The authorization negotiated as provided by Section
  539.051 must also allow for the provision of state Medicaid program
  benefits to recipients in the Medicaid expansion population in a
  manner that:
               (1)  encourages the use of private health benefit
  coverage obtained through a health benefit exchange rather than
  public benefits systems by providing premium assistance;
               (2)  creates customized health benefit plans for
  certain defined populations within the Medicaid expansion group;
               (3)  encourages individuals who have access to private
  employer-based health benefit coverage to obtain or maintain that
  coverage;
               (4)  includes cost-sharing provisions that require a
  recipient to be responsible for the payment of some premiums,
  copayments, and deductibles in amounts not to exceed five percent
  of a recipient's income;
               (5)  establishes wellness initiatives;
               (6)  encourages healthy lifestyles by adjusting
  copayments and deductibles based on certain health risk factors;
               (7)  requires each recipient to undergo an annual
  physical examination with a primary care physician;
               (8)  requires each recipient to lock into one primary
  care physician who will coordinate patient care, including the need
  for diagnostic testing, treatments, and referrals to specialists;
               (9)  contains work requirements for recipients, with
  exceptions for recipients who are disabled, caretakers of disabled
  family members, or caretakers of young children who are not of
  school age; and
               (10)  requires that health benefit plans for recipients
  to be issued on a guaranteed issue basis.
         Sec. 539.053.  IMPLEMENTATION OF BLOCK GRANT SYSTEM. (a) If
  the commission receives the authorization described by Section
  539.052, the commission shall provide state Medicaid program
  benefits to all persons in the Medicaid expansion population who
  apply and are determined eligible for the assistance.
         (b)  The commission shall:
               (1)  provide state Medicaid program benefits to persons
  in the Medicaid expansion population in the manner allowed under
  the authorization; and
               (2)  may not provide benefits to those persons under
  any fee-for-service or managed care delivery model or arrangement
  used to provide benefits to recipients who are not in the Medicaid
  expansion population.
  SUBCHAPTER C. FUNDING REDUCTIONS
         Sec. 539.101.  APPROPRIATIONS REDUCTIONS. The commission
  shall ensure that legislative appropriations requests for the
  commission and health and human services agencies reflect
  reductions in the appropriated amounts needed to provide indigent
  health care services that result from the program implemented under
  this chapter.
         SECTION 3.  The Health and Human Services Commission shall
  actively develop a proposal for the authorization from the
  appropriate federal entity as required by 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 4.  (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 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 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 5.  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.