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A BILL TO BE ENTITLED
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AN ACT
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relating to flexibility in the administration of the Medicaid |
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program, a block grant funding approach to Medicaid expansion, and |
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the establishment of a health benefit exchange tailored to the |
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needs of the state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02105 to read as follows: |
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Sec. 531.02105. FLEXIBILITY FROM FEDERAL REQUIREMENTS. The |
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commission shall negotiate with the United States secretary of |
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health and human services, the federal Centers for Medicare and |
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Medicaid Services, and other appropriate persons for flexibility to |
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adjust the operation of the Medicaid program without the necessity |
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of receiving federal approval for all changes to the program. Any |
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agreement reached must identify broad categories of: |
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(1) program changes that may be made without the need |
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for additional federal approval; and |
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(2) program changes that require additional federal |
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approval. |
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SECTION 2. Subtitle I, Title 4, Government Code, is amended |
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by adding Chapter 539 to read as follows: |
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CHAPTER 539. BLOCK GRANT PROGRAM FOR MEDICAID EXPANSION POPULATION |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 539.001. DEFINITIONS. In this chapter: |
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(1) "Health benefit exchange" means an American Health |
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Benefit Exchange administered by the federal government, an |
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exchange created pursuant to Section 1311(b) of the Patient |
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Protection and Affordable Care Act (42 U.S.C. Section 18031(b)), or |
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a federally-authorized alternative state exchange. |
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(2) "Medicaid expansion population" means the |
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category of persons who would not be eligible for medical |
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assistance under the eligibility criteria in effect on December 31, |
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2013, but for whom federal matching funds are available under the |
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Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as |
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amended by the Health Care Affordable Care Act of 2010 (Pub. L. No. |
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111-152) to provide that assistance. |
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(3) "Medicaid program" means the medical assistance |
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program established and operated under Title XIX of the federal |
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Social Security Act (42 U.S.C. Section 1396 et seq.). |
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(4) "State Medicaid program" means the medical |
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assistance program operated by this state as part of the Medicaid |
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program. |
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Sec. 539.002. CONFLICT WITH OTHER LAW. To the extent of a |
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conflict between a provision of this chapter and another state law, |
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the provision of this chapter controls. |
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SUBCHAPTER B. MEDICAID EXPANSION POPULATION PROGRAM REQUIREMENTS |
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Sec. 539.051. FEDERAL AUTHORIZATION FOR BLOCK GRANT SYSTEM. |
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The commission shall actively negotiate with the United States |
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secretary of health and human services, the federal Centers for |
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Medicare and Medicaid Services, and other appropriate persons for |
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federal authorization for the state to operate the component of the |
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state Medicaid program for providing program benefits to the |
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Medicaid expansion population under a block grant funding system. |
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Sec. 539.052. MINIMUM REQUIREMENTS OF FEDERAL |
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AUTHORIZATION. (a) Federal authorization obtained under Section |
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539.051 must allow for providing state Medicaid program benefits to |
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recipients in the Medicaid expansion population in the form of |
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premium assistance so private health benefit coverage may be |
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obtained through a health benefit exchange. |
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(b) The authorization negotiated as provided by Section |
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539.051 must also allow for the provision of state Medicaid program |
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benefits to recipients in the Medicaid expansion population in a |
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manner that: |
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(1) encourages the use of private health benefit |
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coverage obtained through a health benefit exchange rather than |
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public benefits systems by providing premium assistance; |
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(2) creates customized health benefit plans for |
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certain defined populations within the Medicaid expansion group; |
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(3) encourages individuals who have access to private |
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employer-based health benefit coverage to obtain or maintain that |
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coverage; |
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(4) includes cost-sharing provisions that require a |
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recipient to be responsible for the payment of some premiums, |
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copayments, and deductibles in amounts not to exceed five percent |
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of a recipient's income; |
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(5) establishes wellness initiatives; |
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(6) encourages healthy lifestyles by adjusting |
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copayments and deductibles based on certain health risk factors; |
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(7) requires each recipient to undergo an annual |
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physical examination with a primary care physician; |
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(8) requires each recipient to lock into one primary |
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care physician who will coordinate patient care, including the need |
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for diagnostic testing, treatments, and referrals to specialists; |
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(9) contains work requirements for recipients, with |
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exceptions for recipients who are disabled, caretakers of disabled |
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family members, or caretakers of young children who are not of |
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school age; and |
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(10) requires that health benefit plans for recipients |
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to be issued on a guaranteed issue basis. |
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Sec. 539.053. IMPLEMENTATION OF BLOCK GRANT SYSTEM. (a) If |
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the commission receives the authorization described by Section |
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539.052, the commission shall provide state Medicaid program |
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benefits to all persons in the Medicaid expansion population who |
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apply and are determined eligible for the assistance. |
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(b) The commission shall: |
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(1) provide state Medicaid program benefits to persons |
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in the Medicaid expansion population in the manner allowed under |
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the authorization; and |
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(2) may not provide benefits to those persons under |
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any fee-for-service or managed care delivery model or arrangement |
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used to provide benefits to recipients who are not in the Medicaid |
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expansion population. |
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SUBCHAPTER C. FUNDING REDUCTIONS |
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Sec. 539.101. APPROPRIATIONS REDUCTIONS. The commission |
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shall ensure that legislative appropriations requests for the |
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commission and health and human services agencies reflect |
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reductions in the appropriated amounts needed to provide indigent |
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health care services that result from the program implemented under |
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this chapter. |
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SECTION 3. The Health and Human Services Commission shall |
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actively develop a proposal for the authorization from the |
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appropriate federal entity as required by Chapter 539, Government |
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Code, as added by this Act. As soon as possible after the effective |
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date of this Act, the Health and Human Services Commission shall |
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request and actively pursue obtaining the authorization from the |
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appropriate federal entity. |
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SECTION 4. (a) The Health and Human Services Commission, |
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the Texas Department of Insurance, or the commission in conjunction |
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with the department, shall negotiate with the appropriate federal |
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entity for authorization to develop a state health benefit |
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exchange. The negotiated authorization must allow the state health |
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benefit exchange to be flexible, patient-friendly, tailored to the |
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needs of the state, and be similar to the health benefit exchange |
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described in the Patients' Choice Act, S.B. 516, 111th Congress |
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(2009), or H.R. 2520, 111th Congress (2009). |
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(b) If the appropriate federal entity authorizes a state |
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health benefit exchange described in Subsection (a) of this |
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section, the Health and Human Services Commission, the Texas |
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Department of Insurance, or the commission in conjunction with the |
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department, shall develop and implement the health benefit |
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exchange. |
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SECTION 5. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2013. |