81R1148 KKA-F
By: Hunter H.B. No. 4288
A BILL TO BE ENTITLED
AN ACT
relating to health care coverage for children in Title IV-D cases.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 154.182(b), Family Code, is amended to
read as follows:
(b) In determining the manner in which health care coverage
for the child is to be ordered, the court shall render its order in
accordance with the following priorities, unless a party shows good
cause why a particular order would not be in the best interest of
the child:
(1) if health insurance is available for the child
through a parent's employment or membership in a union, trade
association, or other organization at reasonable cost [to the
parent], the court shall order that parent to include the child in
the parent's health insurance;
(2) if health insurance is not available for the child
under Subdivision (1) but is available to a parent at reasonable
cost from another source, including the program under Section
154.1826 to provide health insurance in Title IV-D cases [and at a
reasonable cost], the court may order that parent to provide health
insurance for the child; or
(3) if health insurance coverage is not available for
the child under Subdivision (1) or (2), the court shall order the
obligor to pay the obligee, in addition to any amount ordered under
the guidelines for child support, an amount, not to exceed nine
percent of the obligor's annual [monthly] resources, as described
by Section 154.062(b), as cash medical support for the child.
SECTION 2. Subchapter D, Chapter 154, Family Code, is
amended by adding Sections 154.1826 and 154.1827 to read as
follows:
Sec. 154.1826. HEALTH CARE PROGRAM FOR CERTAIN CHILDREN IN
TITLE IV-D CASES. (a) In this section:
(1) "Health benefit plan issuer" means an insurer,
health maintenance organization, or other entity authorized to
provide health benefits coverage under this section, including a
primary care case management provider network.
(2) "Health care provider" means a physician or other
person who is licensed, certified, or otherwise authorized to
provide a health care service in this state.
(3) "Program" means the child health care program
developed under this section.
(4) "Reasonable cost" has the meaning assigned by
Section 154.181(e).
(b) In consultation with the Texas Department of Insurance,
the Health and Human Services Commission, and representatives of
the insurance industry in this state, the Title IV-D agency shall
develop and implement a statewide program to address the health
care needs of children in Title IV-D cases for whom health insurance
is not available to either parent at reasonable cost in the manner
described by Section 154.182(b)(1).
(c) The principal objective of the program is to provide
basic health care services, including usual physician services,
office visits, hospitalization, and laboratory, x-ray, and
emergency services, to eligible children in Title IV-D cases at
reasonable cost to the parents obligated by court order to provide
medical support for the children. The health care services
provided are intended to be commensurate in range of services with
the premium reimbursement available to a health benefit plan
issuer.
(d) It is the intent of the legislature that the Title IV-D
agency maximize the use of private resources in administering the
program, including the use of gifts and grants. To the extent
federal money is available for that purpose, the Title IV-D agency
may contract with a third-party administrator to provide enrollment
and related services under the program.
(e) The Title IV-D agency shall adopt rules as necessary to
implement the program. The Title IV-D agency shall consult with the
Health and Human Services Commission and other public and private
health care authorities in establishing policies regarding
benefits provided by the program.
(f) The program may not deny health care coverage to
eligible children because of preexisting conditions or chronic
illnesses, and must provide a uniform schedule of benefits for all
children enrolled in the program. A child who is determined to be
eligible for coverage under the program continues to be eligible
until the termination of the parent's duty to pay child support as
specified by Section 154.006.
(g) The Title IV-D agency shall solicit applications for
participation in the program from health benefit plan issuers who
meet requirements specified by the agency. The Title IV-D agency
shall consult with the Texas Department of Insurance in the
appropriate rating of health benefit plan issuers who apply for
participation in the program. Each health benefit plan issuer who
participates in the program must hold a certificate of authority
issued by the Texas Department of Insurance.
(h) The Title IV-D agency shall promptly notify the courts
of this state when the program has been implemented and is available
to provide for the health care needs of children described by
Subsection (b). The notification must specify a date beginning on
which children may be enrolled in the program.
(i) On or after the date specified in the notification
required by Subsection (h), a court that orders health care
coverage for a child in a Title IV-D case shall order that the child
be enrolled in the program authorized by this section unless other
private health insurance is available for the child at reasonable
cost.
(j) Payment of premium costs for the enrollment of a child
in the program may be enforced against the obligor by any means
available for the enforcement of a child support obligation,
including income withholding under Chapter 158.
(k) To provide the flexibility necessary to provide
services at a reasonable cost to an obligor, and notwithstanding
any provision in the Insurance Code, the program authorized by this
section is not subject to a law that requires:
(1) coverage or the offer of coverage of a particular
health care service or benefit;
(2) coverage or the offer of coverage for the
provision of services by a particular health care provider, other
than a provider selected for participation in the program; or
(3) the use of a particular insurance policy or
contract form or of particular language in a policy or contract
form.
Sec. 154.1827. ADMINISTRATIVE ADJUSTMENT OF MEDICAL
SUPPORT ORDER. (a) In a Title IV-D case in which a medical support
order requires that a child be enrolled in a health care program
under Section 154.1826, the Title IV-D agency may administratively
adjust the order as necessary to reflect changes in the amount of
premium costs associated with the child's enrollment.
(b) The Title IV-D agency shall provide notice of the
administrative adjustment to the obligor and the clerk of the court
that rendered the order.
SECTION 3. This Act takes effect September 1, 2009, except
that Section 2 of this Act takes effect immediately if this Act
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, Section 2 takes effect September 1, 2009.