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A BILL TO BE ENTITLED
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AN ACT
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relating to regional or local health care programs for eligible |
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individuals and employees of small employers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Chapter 75, Health and Safety |
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Code, is amended to read as follows: |
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CHAPTER 75. REGIONAL OR LOCAL HEALTH CARE PROGRAMS FOR ELIGIBLE |
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INDIVIDUALS AND EMPLOYEES OF SMALL EMPLOYERS |
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SECTION 2. Section 75.001, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 75.001. PURPOSE. The purpose of this chapter is to: |
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(1) improve the health of eligible individuals and |
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employees of small employers and their families by improving the |
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individuals' and employees' access to health care and by reducing |
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the number of those individuals and employees who are uninsured; |
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(2) reduce the likelihood that those individuals and |
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employees and their families will require services from |
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state-funded entitlement programs such as Medicaid; |
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(3) contribute to economic development by helping |
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small businesses remain competitive with a healthy workforce and |
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optional health care benefits that will attract employees; and |
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(4) encourage innovative solutions for providing and |
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funding health care services and benefits. |
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SECTION 3. Section 75.002, Health and Safety Code, is |
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amended by amending Subdivisions (1), (3), and (4) and adding |
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Subdivision (1-a) to read as follows: |
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(1) "Eligible individual" means an individual |
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eligible for participation in a regional or local health care |
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program established under this chapter. |
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(1-a) "Employee" means an individual employed by an |
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employer. The term includes a partner of a partnership and the |
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proprietor of a sole proprietorship. |
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(3) "Local health care program" means a local health |
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care program operating in one county and established for the |
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benefit of eligible individuals and the employees of small |
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employers under Subchapter B. |
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(4) "Regional health care program" means a regional |
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health care program operating in two or more counties and |
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established for the benefit of eligible individuals and the |
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employees of small employers under Subchapter B. |
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SECTION 4. Sections 75.052 and 75.053, Health and Safety |
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Code, are amended to read as follows: |
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Sec. 75.052. GOVERNANCE OF PROGRAM. (a) [A regional health
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care program may be operated subject to the direct governance of the
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commissioners courts of the participating counties. A local health
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care program may be operated subject to the direct governance of the
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commissioners court of the participating county.] A regional or |
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local health care program must [may] be operated by a [joint
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council,] tax-exempt nonprofit entity[, or other entity that:
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[(1)
operates the program under a contract with the
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commissioners court or courts, as applicable; or
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[(2)
is an entity in which the county or counties
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participate or that is established or designated by the
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commissioners court or courts, as applicable, to operate the
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program]. |
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(b) An [In selecting an] entity operating [described by
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Subsection (a)(1) or (2) to operate] a regional or local health care |
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program must [, the commissioners court or courts, as applicable,
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shall require, to the extent possible, that the entity] be |
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authorized under federal law to accept donations on a basis that is |
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tax-deductible or otherwise tax-advantaged for the contributor. |
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Sec. 75.053. OPERATION OF PROGRAM. A regional or local |
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health care program provides health care services or benefits to |
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eligible individuals and the employees of participating small |
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employers who are located within the boundaries of the |
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participating county or counties, as applicable. A program may |
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also provide services or benefits to the dependents of those |
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individuals and employees. |
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SECTION 5. Subchapter B, Chapter 75, Health and Safety |
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Code, is amended by adding Section 75.0545 to read as follows: |
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Sec. 75.0545. PARTICIPATION BY ELIGIBLE INDIVIDUALS; SHARE |
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OF COST. Subject to Section 75.153, the governing body may |
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establish criteria for participation in a regional or local health |
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care program by eligible individuals and their dependents. The |
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criteria must require that participating individuals pay a share of |
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the premium or other cost of the program. |
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SECTION 6. Section 75.055(c), Health and Safety Code, is |
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amended to read as follows: |
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(c) A governing body shall actively solicit gifts, grants, |
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and donations to: |
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(1) fund services and benefits provided under the |
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regional or local health care program; and |
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(2) reduce the cost of participation in the program |
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for eligible individuals and for small employers and their |
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employees. |
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SECTION 7. Section 75.101, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 75.101. ALTERNATIVE PROGRAMS AUTHORIZED; PROGRAM |
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OBJECTIVES. In developing a regional or local health care program, |
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a governing body may provide health care services or benefits as |
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described by this subchapter or may develop another type of program |
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to accomplish the purposes of this chapter. A regional or local |
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health care program must be developed, to the extent practicable, |
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to: |
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(1) reduce the number of individuals without health |
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benefit plan coverage [within the boundaries of the participating
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county or counties]; |
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(2) address rising health care costs and reduce the |
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cost of health care services or health benefit plan coverage [for
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small employers and their employees within the boundaries of the
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participating county or counties]; |
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(3) promote preventive care and reduce the incidence |
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of preventable health conditions, such as heart disease, cancer, |
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and diabetes and low birth weight in infants; |
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(4) promote efficient and collaborative delivery of |
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health care services; |
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(5) serve as a model for the innovative use of health |
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information technology to promote efficient delivery of health care |
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services, reduce health care costs, and improve the health of the |
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community; and |
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(6) provide fair payment rates for health care |
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providers, to the extent applicable. |
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SECTION 8. Sections 75.102(a), (c), and (d), Health and |
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Safety Code, are amended to read as follows: |
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(a) A regional or local health care program may provide |
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health care benefits to eligible individuals and the employees of |
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small employers by purchasing or facilitating the purchase of |
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health benefit plan coverage for those individuals and employees |
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from a health benefit plan issuer, including coverage under: |
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(1) a small employer health benefit plan offered under |
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Chapter 1501, Insurance Code; |
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(2) a standard health benefit plan offered under |
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Chapter 1507, Insurance Code; or |
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(3) any other health benefit plan available in this |
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state. |
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(c) Notwithstanding Chapter 1251, Insurance Code, an |
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insurer may issue a group accident and health insurance policy, |
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including a group contract issued by a group hospital service |
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corporation, to cover eligible individuals and the employees of |
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small employers participating in a regional or local health care |
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program. The group policyholder of a policy issued in accordance |
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with this subsection is the governing body or the designee of the |
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governing body. |
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(d) A health maintenance organization may issue a health |
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care plan to cover eligible individuals and the employees of small |
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employers participating in a regional or local health care program. |
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The group contract holder of a contract issued in accordance with |
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this subsection is the governing body or the designee of the |
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governing body. |
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SECTION 9. Sections 75.104(a) and (c), Health and Safety |
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Code, are amended to read as follows: |
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(a) A regional or local health care program may contract |
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with health care providers within the boundaries of the |
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participating county or counties to provide health care services |
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directly to eligible individuals, the employees of participating |
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small employers, and the dependents of those individuals and |
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employees. |
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(c) A governing body that operates a regional or local |
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health care program under this section may require that |
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participating eligible individuals, employees, and dependents |
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obtain health care services only from health care providers that |
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contract to provide those services under the program and may limit |
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the health care services provided under the program to services |
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provided within the boundaries of the program's service area |
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[participating county or counties]. |
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SECTION 10. This Act takes effect September 1, 2017. |