81R6942 ALB-D
By: Rose H.B. No. 1329
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. Section 62.002(2), Health and Safety Code, is
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].
SECTION 2. Section 62.101(b), Health and Safety Code, is
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.
SECTION 3. Sections 62.102(b) and (c), Health and Safety
Code, are amended to read as follows:
(b) During the sixth month following the date of initial
enrollment or reenrollment of an individual whose net family income
exceeds 285 [185] percent of the federal poverty level, the
commission shall:
(1) review the individual's net family income and may
use electronic technology if available and appropriate; and
(2) continue to provide coverage if the individual's
net family income does not exceed the income eligibility limits
prescribed by Section 62.101 [this chapter].
(c) If, during the review required under Subsection (b), the
commission determines that the individual's net family income
exceeds the income eligibility limits prescribed by Section 62.101
[this chapter], the commission may not disenroll the individual
until:
(1) the commission has provided the family an
opportunity to demonstrate that the family's net family income is
within the income eligibility limits prescribed by Section 62.101
[this chapter]; and
(2) the family fails to demonstrate such eligibility.
SECTION 4. Section 62.151, Health and Safety Code, is
amended by adding Subsection (g) to read as follows:
(g) In developing the plan, the commission, subject to
federal requirements, may choose to provide dental benefits at full
cost to the enrollee as an available plan option for a child whose
net family income is greater than 200 percent but not greater than
300 percent of the federal poverty level.
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 amount of the share required to be paid must:
(1) 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
(2) 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 only to a child who was covered by an
employer-sponsored group health benefits plan at any time during
the 180 days before the date of application for coverage under the
child health plan.
SECTION 7. 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 of the federal poverty level are
eligible to purchase health benefits 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;
(2) ensure that premiums:
(A) are based on the average cost per child of all
children enrolled in the child health plan program; and
(B) progressively increase as the number of
children in the enrollee's family provided coverage increases;
(3) require payment of 100 percent of health benefits
plan premiums, fees to offset administrative costs incurred under
this subchapter, and additional deductibles, coinsurance, or other
cost-sharing payments as determined by the executive commissioner;
(4) provide for a waiting period comparable to the
waiting period required under Section 62.154(e); and
(5) include an option for an enrollee to pay monthly
premiums using direct debits to bank accounts or credit cards.
(b) Notwithstanding any other provision of this chapter,
the executive commissioner may establish rules and procedures for
children for whom health benefits coverage is purchased under this
subchapter that differ from the rules 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. The commission shall include a
lock-out period for the buy-in option developed under this
subchapter.
SECTION 8. Not later than January 1, 2010, 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 9. 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 10. This Act takes effect September 1, 2009.