Texas 2009 - 81st Regular

Texas House Bill HB1329 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R6942 ALB-D
2	2	By: Rose H.B. No. 1329
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the child health plan program.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Section 62.002(2), Health and Safety Code, is
10	10	amended to read as follows:
11	11	(2) "Executive commissioner" or "commissioner
12	12	[Commissioner]" means the executive commissioner of the Health
13	13	[health] and Human Services Commission [human services].
14	14	SECTION 2. Section 62.101(b), Health and Safety Code, is
15	15	amended to read as follows:
16	16	(b) The commission shall establish income eligibility
17	17	levels consistent with Title XXI, Social Security Act (42 U.S.C.
18	18	Section 1397aa et seq.), as amended, and any other applicable law or
19	19	regulations, and subject to the availability of appropriated money,
20	20	so that a child who is younger than 19 years of age and whose net
21	21	family income is at or below 300 [200] percent of the federal
22	22	poverty level is eligible for health benefits coverage under the
23	23	program. In addition, the commission may establish eligibility
24	24	standards regarding the amount and types of allowable assets for a
25	25	family whose net family income is above 250 [150] percent of the
26	26	federal poverty level.
27	27	SECTION 3. Sections 62.102(b) and (c), Health and Safety
28	28	Code, are amended to read as follows:
29	29	(b) During the sixth month following the date of initial
30	30	enrollment or reenrollment of an individual whose net family income
31	31	exceeds 285 [185] percent of the federal poverty level, the
32	32	commission shall:
33	33	(1) review the individual's net family income and may
34	34	use electronic technology if available and appropriate; and
35	35	(2) continue to provide coverage if the individual's
36	36	net family income does not exceed the income eligibility limits
37	37	prescribed by Section 62.101 [this chapter].
38	38	(c) If, during the review required under Subsection (b), the
39	39	commission determines that the individual's net family income
40	40	exceeds the income eligibility limits prescribed by Section 62.101
41	41	[this chapter], the commission may not disenroll the individual
42	42	until:
43	43	(1) the commission has provided the family an
44	44	opportunity to demonstrate that the family's net family income is
45	45	within the income eligibility limits prescribed by Section 62.101
46	46	[this chapter]; and
47	47	(2) the family fails to demonstrate such eligibility.
48	48	SECTION 4. Section 62.151, Health and Safety Code, is
49	49	amended by adding Subsection (g) to read as follows:
50	50	(g) In developing the plan, the commission, subject to
51	51	federal requirements, may choose to provide dental benefits at full
52	52	cost to the enrollee as an available plan option for a child whose
53	53	net family income is greater than 200 percent but not greater than
54	54	300 percent of the federal poverty level.
55	55	SECTION 5. Section 62.153, Health and Safety Code, is
56	56	amended by amending Subsections (a) and (c) and adding Subsections
57	57	(a-1) and (a-2) to read as follows:
58	58	(a) To the extent permitted under 42 U.S.C. Section 1397cc,
59	59	as amended, and any other applicable law or regulations, the
60	60	commission shall require enrollees whose net family incomes are at
61	61	or below 200 percent of the federal poverty level to share the cost
62	62	of the child health plan, including provisions requiring enrollees
63	63	under the child health plan to pay:
64	64	(1) a copayment for services provided under the plan;
65	65	(2) an enrollment fee; or
66	66	(3) a portion of the plan premium.
67	67	(a-1) The commission shall require enrollees whose net
68	68	family incomes are greater than 200 percent but not greater than 300
69	69	percent of the federal poverty level to pay a share of the cost of
70	70	the child health plan through copayments, fees, and a portion of the
71	71	plan premium. The amount of the share required to be paid must:
72	72	(1) exceed the amount required to be paid by enrollees
73	73	described by Subsection (a), but the total amount required to be
74	74	paid may not exceed five percent of an enrollee's net family income;
75	75	and
76	76	(2) increase incrementally, as determined by the
77	77	commission, as an enrollee's net family income increases.
78	78	(a-2) In establishing the cost required to be paid by an
79	79	enrollee described by Subsection (a-1) as a portion of the plan
80	80	premium, the commission shall ensure that the cost progressively
81	81	increases as the number of children in the enrollee's family
82	82	provided coverage increases.
83	83	(c) The [If cost-sharing provisions imposed under
84	84	Subsection (a) include requirements that enrollees pay a portion of
85	85	the plan premium, the] commission shall specify the manner of
86	86	payment for any portion of the plan premium required to be paid by
87	87	an enrollee under this section [in which the premium is paid]. The
88	88	commission may require that the premium be paid to the [Texas
89	89	Department of] Health and Human Services Commission, the [Texas]
90	90	Department of State Health [Human] Services, or the health plan
91	91	provider. The commission shall develop an option for an enrollee to
92	92	pay monthly premiums using direct debits to bank accounts or credit
93	93	cards.
94	94	SECTION 6. Section 62.154, Health and Safety Code, is
95	95	amended by amending Subsection (d) and adding Subsection (e) to
96	96	read as follows:
97	97	(d) The waiting period required by Subsection (a) for a
98	98	child whose net family income is at or below 200 percent of the
99	99	federal poverty level must:
100	100	(1) extend for a period of 90 days after the last date
101	101	on which the applicant was covered under a health benefits plan; and
102	102	(2) apply to a child who was covered by a health
103	103	benefits plan at any time during the 90 days before the date of
104	104	application for coverage under the child health plan.
105	105	(e) The waiting period required by Subsection (a) for a
106	106	child whose net family income is greater than 200 percent but not
107	107	greater than 300 percent of the federal poverty level must:
108	108	(1) extend for a period of 180 days after the last
109	109	date on which the applicant was covered under a health benefits
110	110	plan; and
111	111	(2) apply only to a child who was covered by an
112	112	employer-sponsored group health benefits plan at any time during
113	113	the 180 days before the date of application for coverage under the
114	114	child health plan.
115	115	SECTION 7. Chapter 62, Health and Safety Code, is amended by
116	116	adding Subchapter F to read as follows:
117	117	SUBCHAPTER F. BUY-IN OPTION
118	118	Sec. 62.251. BUY-IN OPTION FOR CERTAIN CHILDREN. The
119	119	executive commissioner shall develop and implement a buy-in option
120	120	in accordance with this subchapter under which children whose net
121	121	family incomes exceed 300 percent of the federal poverty level are
122	122	eligible to purchase health benefits coverage available under the
123	123	child health plan program.
124	124	Sec. 62.252. RULES; ELIGIBILITY AND COST-SHARING. (a) The
125	125	executive commissioner shall adopt rules in accordance with federal
126	126	law that apply to a child for whom health benefits coverage is
127	127	purchased under this subchapter. The rules must:
128	128	(1) establish eligibility requirements;
129	129	(2) ensure that premiums:
130	130	(A) are based on the average cost per child of all
131	131	children enrolled in the child health plan program; and
132	132	(B) progressively increase as the number of
133	133	children in the enrollee's family provided coverage increases;
134	134	(3) require payment of 100 percent of health benefits
135	135	plan premiums, fees to offset administrative costs incurred under
136	136	this subchapter, and additional deductibles, coinsurance, or other
137	137	cost-sharing payments as determined by the executive commissioner;
138	138	(4) provide for a waiting period comparable to the
139	139	waiting period required under Section 62.154(e); and
140	140	(5) include an option for an enrollee to pay monthly
141	141	premiums using direct debits to bank accounts or credit cards.
142	142	(b) Notwithstanding any other provision of this chapter,
143	143	the executive commissioner may establish rules and procedures for
144	144	children for whom health benefits coverage is purchased under this
145	145	subchapter that differ from the rules and procedures generally
146	146	applicable to the child health plan program.
147	147	Sec. 62.253. CROWD-OUT. To the extent allowed by federal
148	148	law, the buy-in option developed under this subchapter must include
149	149	provisions designed to discourage:
150	150	(1) employers and other persons from electing to
151	151	discontinue offering health benefits plan coverage for employees'
152	152	children under employee or other group health benefits plans; and
153	153	(2) individuals with access to adequate health
154	154	benefits plan coverage for their children through an
155	155	employer-sponsored group health benefits plan, as determined by the
156	156	executive commissioner, from electing not to obtain, or to
157	157	discontinue, that coverage.
158	158	Sec. 62.254. POINT-OF-SERVICE COPAYMENT. The commission
159	159	shall establish point-of-service copayments for the buy-in option
160	160	developed under this subchapter that are higher than
161	161	point-of-service copayments required for a child whose net family
162	162	income is at or below 300 percent of the federal poverty level.
163	163	Sec. 62.255. LOCK-OUT. The commission shall include a
164	164	lock-out period for the buy-in option developed under this
165	165	subchapter.
166	166	SECTION 8. Not later than January 1, 2010, the executive
167	167	commissioner of the Health and Human Services Commission shall
168	168	adopt rules as necessary to implement Subchapter F, Chapter 62,
169	169	Health and Safety Code, as added by this Act.
170	170	SECTION 9. If before implementing any provision of this Act
171	171	a state agency determines that a waiver or authorization from a
172	172	federal agency is necessary for implementation of that provision,
173	173	the agency affected by the provision shall request the waiver or
174	174	authorization and may delay implementing that provision until the
175	175	waiver or authorization is granted.
176	176	SECTION 10. This Act takes effect September 1, 2009.