Texas 2009 - 81st Regular

Texas House Bill HB1769 Compare Versions

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

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1	1	81R4226 KFF-D
2	2	By: Turner of Harris H.B. No. 1769
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 150 percent of the federal
26	26	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 185 percent of the federal poverty level, the commission
32	32	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, excluding any amounts paid for coverage authorized by Section
75	75	62.151(g), may not exceed the maximum amount allowed under 42
76	76	C.F.R. Section 457.560 or other applicable federal law; and
77	77	(2) increase incrementally, as determined by the
78	78	commission, as an enrollee's net family income increases.
79	79	(a-2) In establishing the cost required to be paid by an
80	80	enrollee described by Subsection (a-1) as a portion of the plan
81	81	premium, the commission shall ensure that the cost progressively
82	82	increases as the number of children in the enrollee's family
83	83	provided coverage increases.
84	84	(c) The [If cost-sharing provisions imposed under
85	85	Subsection (a) include requirements that enrollees pay a portion of
86	86	the plan premium, the] commission shall specify the manner of
87	87	payment for any portion of the plan premium required to be paid by
88	88	an enrollee under this section [in which the premium is paid]. The
89	89	commission may require that the premium be paid to the [Texas
90	90	Department of] Health and Human Services Commission, the [Texas]
91	91	Department of State Health [Human] Services, or the health plan
92	92	provider. The commission shall develop an option for an enrollee to
93	93	pay monthly premiums using direct debits to bank accounts or credit
94	94	cards.
95	95	SECTION 6. Section 62.154, Health and Safety Code, is
96	96	amended by amending Subsection (d) and adding Subsections (e) and
97	97	(f) to read as follows:
98	98	(d) The waiting period required by Subsection (a) for a
99	99	child whose net family income is at or below 200 percent of the
100	100	federal poverty level must:
101	101	(1) extend for a period of 90 days after the last date
102	102	on which the applicant was covered under a health benefits plan; and
103	103	(2) apply to a child who was covered by a health
104	104	benefits plan at any time during the 90 days before the date of
105	105	application for coverage under the child health plan.
106	106	(e) The waiting period required by Subsection (a) for a
107	107	child whose net family income is greater than 200 percent but not
108	108	greater than 300 percent of the federal poverty level must:
109	109	(1) extend for a period of 180 days after the last
110	110	date on which the applicant was covered under a health benefits
111	111	plan; and
112	112	(2) apply only to a child who was covered by an
113	113	employer-sponsored group health benefits plan at any time during
114	114	the 180 days before the date of application for coverage under the
115	115	child health plan.
116	116	(f) If a child has a serious or chronic medical condition,
117	117	as defined by rules adopted by the executive commissioner, the
118	118	commission shall, in determining the cost to the child's family for
119	119	the coverage under Subsection (b)(2), include the health benefits
120	120	plan premiums and any cost-sharing expenses paid by the family
121	121	under the terminated health benefits plan and any health care
122	122	equipment or supplies purchased by the family that were not covered
123	123	by the plan.
124	124	SECTION 7. Chapter 62, Health and Safety Code, is amended by
125	125	adding Subchapter F to read as follows:
126	126	SUBCHAPTER F. BUY-IN OPTION
127	127	Sec. 62.251. BUY-IN OPTION FOR CERTAIN CHILDREN. The
128	128	executive commissioner shall develop and implement a buy-in option
129	129	in accordance with this subchapter under which children whose net
130	130	family incomes exceed 300 percent of the federal poverty level are
131	131	eligible to purchase health benefits coverage available under the
132	132	child health plan program.
133	133	Sec. 62.252. RULES; ELIGIBILITY AND COST-SHARING. (a) The
134	134	executive commissioner shall adopt rules in accordance with federal
135	135	law that apply to a child for whom health benefits coverage is
136	136	purchased under this subchapter. The rules must:
137	137	(1) establish eligibility requirements;
138	138	(2) ensure that premiums:
139	139	(A) are based on the average cost per child of all
140	140	children enrolled in the child health plan program; and
141	141	(B) progressively increase as the number of
142	142	children in the enrollee's family provided coverage increases;
143	143	(3) require payment of 100 percent of health benefits
144	144	plan premiums, fees to offset administrative costs incurred under
145	145	this subchapter, and additional deductibles, coinsurance, or other
146	146	cost-sharing payments as determined by the executive commissioner;
147	147	(4) provide for a waiting period comparable to the
148	148	waiting period required under Section 62.154(e); and
149	149	(5) include an option for an enrollee to pay monthly
150	150	premiums using direct debits to bank accounts or credit cards.
151	151	(b) Notwithstanding any other provision of this chapter,
152	152	the executive commissioner may establish rules and procedures for
153	153	children for whom health benefits coverage is purchased under this
154	154	subchapter that differ from the rules and procedures generally
155	155	applicable to the child health plan program.
156	156	Sec. 62.253. CROWD-OUT. To the extent allowed by federal
157	157	law, the buy-in option developed under this subchapter must include
158	158	provisions designed to discourage:
159	159	(1) employers and other persons from electing to
160	160	discontinue offering health benefits plan coverage for employees'
161	161	children under employee or other group health benefits plans; and
162	162	(2) individuals with access to adequate health
163	163	benefits plan coverage for their children through an
164	164	employer-sponsored group health benefits plan, as determined by the
165	165	executive commissioner, from electing not to obtain, or to
166	166	discontinue, that coverage.
167	167	Sec. 62.254. POINT-OF-SERVICE COPAYMENT. The commission
168	168	shall establish point-of-service copayments for the buy-in option
169	169	developed under this subchapter that are higher than
170	170	point-of-service copayments required for a child whose net family
171	171	income is at or below 300 percent of the federal poverty level.
172	172	Sec. 62.255. LOCK-OUT. The commission shall include a
173	173	lock-out period for the buy-in option developed under this
174	174	subchapter designed to discourage individuals from electing to
175	175	discontinue coverage when the individual's children are healthy.
176	176	Sec. 62.256. ENROLLMENT OF ALL CHILDREN IN FAMILY. (a) If
177	177	one child in an eligible family enrolls in the buy-in option
178	178	developed under this subchapter, the commission shall require that
179	179	each eligible child in the family enroll in the buy-in option.
180	180	(b) Subsection (a) does not apply to a child who:
181	181	(1) receives coverage under a health benefits plan
182	182	from a noncustodial parent under a medical support order; or
183	183	(2) is eligible for medical assistance under the
184	184	Medicaid program or coverage under the Texas Health Insurance Risk
185	185	Pool under Chapter 1506, Insurance Code.
186	186	SECTION 8. Not later than January 1, 2010, the executive
187	187	commissioner of the Health and Human Services Commission shall
188	188	adopt rules as necessary to implement Subchapter F, Chapter 62,
189	189	Health and Safety Code, as added by this Act.
190	190	SECTION 9. If before implementing any provision of this Act
191	191	a state agency determines that a waiver or authorization from a
192	192	federal agency is necessary for implementation of that provision,
193	193	the agency affected by the provision shall request the waiver or
194	194	authorization and may delay implementing that provision until the
195	195	waiver or authorization is granted.
196	196	SECTION 10. This Act takes effect September 1, 2009.