81R10350 KLA-D
By: Coleman H.B. No. 2962
A BILL TO BE ENTITLED
AN ACT
relating to eligibility for and administration of the child health
plan and Medicaid programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02417 to read as follows:
Sec. 531.02417. ENROLLMENT AND RETENTION MODIFICATIONS FOR
RECEIPT OF FEDERAL BONUS PAYMENTS. (a) Notwithstanding any other
provision of this chapter, Chapter 62, Health and Safety Code,
Chapter 32, Human Resources Code, or any other law, the commission
shall take all necessary actions to modify enrollment and retention
processes employed in the child health plan and Medicaid programs
to ensure that this state receives federal performance bonus
payments made available under Section 2105(a)(3), Social Security
Act (42 U.S.C. Section 1397ee(a)(3)), or, if an enrollment and
retention process employed in those programs does not require a
modification, maintain the process to ensure receipt of those
payments.
(b) Actions the commission is required to take under
Subsection (a) include implementing or maintaining the following
with respect to children younger than 19 years of age:
(1) a 12-month period of continuous eligibility for
the child health plan and Medicaid programs, as required by Section
62.102, Health and Safety Code, and Section 32.0261, Human
Resources Code, respectively;
(2) liberalizing asset test requirements for
eligibility determinations for the child health plan and Medicaid
programs, which may include:
(A) eliminating the asset test regardless of
whether the test is specifically authorized by statute; or
(B) permitting an applicant, or the applicant's
parent or guardian, to certify under penalty of perjury information
relating to assets or using an asset verification process that does
not require an applicant, or the applicant's parent or guardian, to
provide documentation except when discrepancies are discovered or
under other circumstances that justify requiring documentation, as
determined by the executive commissioner in accordance with federal
law;
(3) eliminating any personal interview requirements
for determining eligibility for the child health plan or Medicaid
programs, notwithstanding any other law;
(4) using the same application, set of supplemental
forms, if applicable, and information verification process for
determining eligibility for the child health plan and Medicaid
programs; and
(5) using automatic, administrative processes for
recertifying eligibility for the child health plan and Medicaid
programs that comply with the requirements specified by Section
2105(a)(4)(E), Social Security Act (42 U.S.C. Section
1397ee(a)(4)(E)), including:
(A) providing a preprinted form completed by the
commission or a person contracting with the commission to perform
eligibility and enrollment functions that is based on available
information, unless other information is provided or obtained
through verification; and
(B) using an ex parte process under which no
personal interview is required unless the commission, or the person
contracting with the commission to perform eligibility and
enrollment functions, does not have sufficient information to
recertify eligibility and that information cannot be acquired from
other sources without the participation of an applicant or the
applicant's parent or guardian.
SECTION 2. Sections 62.002(2) and (4), Health and Safety
Code, are 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].
(4) "Net family income" means the amount of income
established for a family after reduction for offsets for expenses
such as child care and work-related expenses, in accordance with
standards applicable under the Medicaid program.
SECTION 3. 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 150 percent of the federal
poverty level.]
SECTION 4. Section 62.102(a), Health and Safety Code, is
amended to read as follows:
(a) The [Subject to a review under Subsection (b), the]
commission shall provide that an individual who is determined to be
eligible for coverage under the child health plan remains eligible
for those benefits until the earlier of:
(1) the end of a period not to exceed 12 months,
beginning the first day of the month following the date of the
eligibility determination; or
(2) the individual's 19th birthday.
SECTION 5. Section 62.151(b), Health and Safety Code, is
amended to read as follows:
(b) In developing the covered benefits, the commission
shall consider the health care needs of healthy children and
children with special health care needs. The child health plan must
provide at least the covered benefits described by the recommended
benefits package described for a state-designed child health plan
by the Texas House of Representatives Committee on Public Health
"CHIP" Interim Report to the Seventy-Sixth Texas Legislature dated
December 1998 and the Senate Interim Committee on Children's Health
Insurance Report to the Seventy-Sixth Texas Legislature dated
December 1, 1998. The child health plan must include at least the
covered benefits provided under the plan on June 1, 2003.
SECTION 6. Section 62.153(b), Health and Safety Code, is
amended to read as follows:
(b) Cost-sharing [Subject to Subsection (d), cost-sharing]
provisions adopted under this section shall ensure that families
with higher levels of income are required to pay progressively
higher percentages of the cost of the plan.
SECTION 7. Sections 62.155(c) and (d), Health and Safety
Code, are amended to read as follows:
(c) In selecting a health plan provider, the commission:
(1) may give preference to a person who provides
similar coverage under the Medicaid program; and
(2) shall provide for a choice of at least two health
plan providers in each metropolitan [service] area.
(d) The commissioner may authorize an exception to
Subsection (c)(2) if there is only one acceptable applicant to
become a health plan provider in the metropolitan [service] area.
SECTION 8. 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, but
do not exceed 400 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) 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;
and
(3) provide for a waiting period comparable to the
waiting period required under Section 62.154(d).
(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.
SECTION 9. Section 32.0261, Human Resources Code, is
amended to read as follows:
Sec. 32.0261. CONTINUOUS ELIGIBILITY. The department
shall adopt rules in accordance with 42 U.S.C. Section
1396a(e)(12), as amended, to provide for a period of continuous
eligibility for a child under 19 years of age who is determined to
be eligible for medical assistance under this chapter. The rules
shall provide that the child remains eligible for medical
assistance, without additional review by the department and
regardless of changes in the child's resources or income, until the
earlier of:
(1) the first anniversary of [end of the six-month
period following] the date on which the child's eligibility was
determined; or
(2) the child's 19th birthday.
SECTION 10. Sections 62.101(b-1), 62.102(b) and (c),
62.151(f), and 62.153(d), Health and Safety Code, are repealed.
SECTION 11. Not later than November 1, 2009, 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 12. The changes in law made by this Act apply to an
initial determination of eligibility or a recertification of
eligibility for the child health plan program under Chapter 62,
Health and Safety Code, or the medical assistance program under
Chapter 32, Human Resources Code, made on or after September 1,
2009.
SECTION 13. 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 14. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2009.