Texas 2009 - 81st Regular

Texas Senate Bill SB6 Compare Versions

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1	1	81R4816 KCR-F
2	2	By: Duncan, Nelson S.B. No. 6
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the creation of the Healthy Texas Program.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
10	10	by adding Chapter 1508 to read as follows:
11	11	CHAPTER 1508. HEALTHY TEXAS PROGRAM
12	12	SUBCHAPTER A. GENERAL PROVISIONS
13	13	Sec. 1508.001. PURPOSE. (a) The purposes of the Healthy
14	14	Texas Program are to:
15	15	(1) provide access to quality small employer health
16	16	benefit plans at an affordable price;
17	17	(2) encourage small employers to offer health benefit
18	18	plan coverage to employees and the dependents of employees; and
19	19	(3) maximize reliance on proven managed care
20	20	strategies and procedures.
21	21	(b) The Healthy Texas Program is not intended to diminish
22	22	the availability of traditional small employer health benefit plan
23	23	coverage under Chapter 1501.
24	24	Sec. 1508.002. DEFINITIONS. In this chapter:
25	25	(1) "Dependent" has the meaning assigned by Section
26	26	1501.002(2).
27	27	(2) "Eligible employee" has the meaning assigned by
28	28	Section 1501.002(3).
29	29	(3) "Fund" means the healthy Texas small employer
30	30	premium stabilization fund established under Subchapter F.
31	31	(4) "Health benefit plan" and "health benefit plan
32	32	issuer" have the meanings assigned by Sections 1501.002(5) and
33	33	1501.002(6), respectively.
34	34	(5) "Program" means the Healthy Texas Program
35	35	established under this chapter.
36	36	(6) "Qualifying health benefit plan" means a health
37	37	benefit plan that provides benefits for health care services in the
38	38	manner described by this chapter.
39	39	(7) "Small employer" has the meaning assigned by
40	40	Section 1501.002(14).
41	41	Sec. 1508.003. RULES. The commissioner may adopt rules as
42	42	necessary to implement this chapter.
43	43	[Sections 1508.004-1508.050 reserved for expansion]
44	44	SUBCHAPTER B. EMPLOYER ELIGIBILITY; CONTRIBUTIONS
45	45	Sec. 1508.051. EMPLOYER ELIGIBILITY TO PARTICIPATE. (a) A
46	46	small employer may participate in the program if:
47	47	(1) during the 12-month period immediately preceding
48	48	the date of application for a qualifying health benefit plan, the
49	49	small employer does not offer employees group health benefits on an
50	50	expense-reimbursed or prepaid basis; and
51	51	(2) at least 30 percent of the small employer's
52	52	eligible employees receive annual wages from the employer in an
53	53	amount that is equal to or less than 300 percent of the poverty
54	54	guidelines for an individual, as defined and updated annually by
55	55	the United States Department of Health and Human Services.
56	56	(b) A small employer ceases to be eligible to participate in
57	57	the program if any health benefit plan that provides employee
58	58	benefits on an expense-reimbursed or prepaid basis, other than
59	59	another qualifying health benefit plan, is purchased or otherwise
60	60	takes effect after the purchase of a qualifying health benefit
61	61	plan.
62	62	Sec. 1508.052. COMMISSIONER ADJUSTMENTS AUTHORIZED. (a)
63	63	The commissioner by rule may adjust the 12-month period described
64	64	by Section 1508.051(a)(1) to an 18-month period if the commissioner
65	65	determines that the 12-month period is insufficient to prevent
66	66	inappropriate substitution of other health benefit plans for
67	67	qualifying health benefit plan coverage under this chapter.
68	68	(b) The commissioner by rule may adjust the percentage of
69	69	the poverty guidelines described by Section 1508.051(a)(2) to a
70	70	higher or lower percentage if the commissioner determines that the
71	71	adjustment is necessary to fulfill the purposes of this chapter. An
72	72	adjustment made by the commissioner under this subsection takes
73	73	effect on the first July 1 following the adjustment.
74	74	Sec. 1508.053. MINIMUM EMPLOYER PARTICIPATION
75	75	REQUIREMENTS. A small employer that meets the eligibility
76	76	requirements described by Section 1508.051(a) may apply to purchase
77	77	a qualifying health benefit plan if 60 percent or more of the
78	78	employer's eligible employees elect to participate in the plan.
79	79	Sec. 1508.054. EMPLOYER CONTRIBUTION REQUIREMENTS. (a) A
80	80	small employer that purchases a qualifying health benefit plan
81	81	must:
82	82	(1) pay 50 percent or more of the premium for each
83	83	employee covered under the qualifying health benefit plan;
84	84	(2) offer coverage to all eligible employees receiving
85	85	annual wages from the employer in an amount described by Section
86	86	1508.051(a)(2) or 1508.052(b), as applicable; and
87	87	(3) contribute the same percentage of premium for each
88	88	covered employee.
89	89	(b) A small employer that purchases a qualifying health
90	90	benefit plan under the program may elect to pay, but is not required
91	91	to pay, all or any portion of the premium paid for dependent
92	92	coverage under the qualifying health benefit plan.
93	93	[Sections 1508.055-1508.100 reserved for expansion]
94	94	SUBCHAPTER C. PROGRAM PARTICIPATION; REQUIRED COVERAGE AND
95	95	BENEFITS
96	96	Sec. 1508.101. PARTICIPATING PLAN ISSUERS. (a) Subject to
97	97	Subsection (b), any health benefit plan issuer may participate in
98	98	the program.
99	99	(b) The commissioner by rule may limit which health benefit
100	100	plan issuers may participate in the program if the commissioner
101	101	determines that the limitation is necessary to achieve the purposes
102	102	of this chapter.
103	103	(c) If the commissioner limits participation in the program
104	104	under Subsection (b), the commissioner shall contract on a
105	105	competitive procurement basis with one or more health benefit plan
106	106	issuers to provide qualifying health benefit plan coverage under
107	107	the program.
108	108	Sec. 1508.102. PREEXISTING CONDITION PROVISION REQUIRED. A
109	109	health benefit plan offered under the program must include a
110	110	preexisting condition provision that meets the requirements
111	111	described by Section 1501.102.
112	112	Sec. 1508.103. EXCEPTION FROM MANDATED BENEFIT
113	113	REQUIREMENTS. Except as expressly provided by this chapter, a
114	114	small employer health benefit plan issued under the program is not
115	115	subject to a law of this state that requires coverage or the offer
116	116	of coverage of a health care service or benefit.
117	117	Sec. 1508.104. CERTAIN COVERAGE PROHIBITED OR REQUIRED.
118	118	(a) A qualifying health benefit plan may only provide coverage for
119	119	in-plan services and benefits, except for:
120	120	(1) emergency care; or
121	121	(2) other services not available through a plan
122	122	provider.
123	123	(b) In-plan services and benefits provided under a
124	124	qualifying health benefit plan must include the following:
125	125	(1) inpatient hospital services;
126	126	(2) outpatient hospital services;
127	127	(3) physician services; and
128	128	(4) prescription drug benefits.
129	129	(c) The commissioner may approve in-plan benefits other
130	130	than those required under Subsection (b) or emergency care or other
131	131	services not available through a plan provider if the commissioner
132	132	determines the inclusion to be essential to achieve the purposes of
133	133	this chapter.
134	134	(d) The commissioner may, with respect to the categories of
135	135	services and benefits described by Subsections (b) and (c):
136	136	(1) prepare specifications for a coverage provided
137	137	under this chapter;
138	138	(2) determine the methods and procedures of claims
139	139	administration;
140	140	(3) establish procedures to decide contested cases
141	141	arising from coverage provided under this chapter;
142	142	(4) study, on an ongoing basis, the operation of all
143	143	coverages provided under this chapter, including gross and net
144	144	costs, administration costs, benefits, utilization of benefits,
145	145	and claims administration;
146	146	(5) administer the healthy Texas small employer
147	147	premium stabilization fund established under Subchapter F;
148	148	(6) provide the beginning and ending dates of
149	149	coverages for enrollees in a qualifying health benefit plan;
150	150	(7) develop basic group coverage plans applicable to
151	151	all individuals eligible to participate in the program;
152	152	(8) provide for optional group coverage plans in
153	153	addition to the basic group coverage plans described by Subdivision
154	154	(7);
155	155	(9) provide, as determined to be appropriate by the
156	156	commissioner, additional statewide optional coverage plans;
157	157	(10) develop specific health benefit plans that permit
158	158	access to high-quality, cost-effective health care;
159	159	(11) design, implement, and monitor health benefit
160	160	plan features intended to discourage excessive utilization,
161	161	promote efficiency, and contain costs for qualifying health benefit
162	162	plans;
163	163	(12) develop and refine, on an ongoing basis, a health
164	164	benefit strategy for the program that is consistent with evolving
165	165	benefits delivery systems;
166	166	(13) develop a funding strategy that efficiently uses
167	167	employer contributions to achieve the purposes of this chapter; and
168	168	(14) modify the copayment and deductible amounts for
169	169	prescription drug benefits under a qualifying health benefit plan,
170	170	if the commissioner determines that the modification is necessary
171	171	to achieve the purposes of this chapter.
172	172	[Sections 1508.105-1508.150 reserved for expansion]
173	173	SUBCHAPTER D. PROGRAM ADMINISTRATION
174	174	Sec. 1508.151. EMPLOYER CERTIFICATION. (a) At the time of
175	175	initial application, a health benefit plan issuer shall obtain from
176	176	a small employer that seeks to purchase a qualifying health benefit
177	177	plan a written certification that the employer meets the
178	178	eligibility requirements described by Section 1508.051 and the
179	179	minimum employer participation requirements described by Section
180	180	1508.053.
181	181	(b) Not later than the 90th day before the renewal date of a
182	182	qualifying health benefit plan, a health benefit plan issuer shall
183	183	obtain from the small employer that purchased the qualifying health
184	184	benefit plan a written certification that the employer continues to
185	185	meet the eligibility requirements described by Section 1508.051 and
186	186	the minimum employer participation requirements described by
187	187	Section 1508.053.
188	188	(c) A participating health benefit plan issuer may require a
189	189	small employer to submit appropriate documentation in support of a
190	190	certification described by Subsection (a) or (b).
191	191	Sec. 1508.152. APPLICATION PROCESS. (a) Subject to
192	192	Subsection (b), a health benefit plan issuer shall accept
193	193	applications for qualifying health benefit plan coverage from small
194	194	employers at all times throughout the calendar year.
195	195	(b) The commissioner may limit the dates on which a health
196	196	benefit plan issuer must accept applications for qualifying health
197	197	benefit plan coverage if the commissioner determines the limitation
198	198	to be necessary to achieve the purposes of this chapter.
199	199	Sec. 1508.153. EMPLOYEE ENROLLMENT; WAITING PERIOD. (a) A
200	200	qualifying health benefit plan must provide employees with an
201	201	initial enrollment period that is 31 days or longer, and annually at
202	202	least one open enrollment period that is 31 days or longer. The
203	203	commissioner by rule may require an additional open enrollment
204	204	period if the commissioner determines that the additional open
205	205	enrollment period is necessary to achieve the purposes of this
206	206	chapter.
207	207	(b) A small employer may establish a waiting period for
208	208	employees during which an employee is not eligible for coverage
209	209	under a qualifying health benefit plan. The last day of a waiting
210	210	period established under this subsection may not be later than the
211	211	90th day after the date on which the employee begins employment
212	212	with the small employer.
213	213	(c) A health benefit plan issuer may not deny coverage under
214	214	a qualifying health benefit plan to a new employee of a small
215	215	employer that purchased the qualifying health benefit plan if the
216	216	health benefit plan issuer receives an application for coverage
217	217	from the employee not later than the 31st day after the latter of:
218	218	(1) the first day of the employee's employment; or
219	219	(2) the first day after the expiration of a waiting
220	220	period established under Subsection (b).
221	221	(d) Subject to Subsection (e), a health benefit plan issuer
222	222	may deny coverage under a qualifying health benefit plan to an
223	223	employee of a small employer who applies for coverage after the
224	224	period described by Subsection (c).
225	225	(e) A health benefit plan issuer that denies an employee
226	226	coverage under Subsection (d):
227	227	(1) may only deny the employee coverage until the next
228	228	open enrollment period; and
229	229	(2) may subject the enrollee to a one-year preexisting
230	230	condition provision, as described by Section 1508.102, if the
231	231	period during which the preexisting condition provision applies
232	232	does not exceed 18 months from the date of the initial application
233	233	for coverage under the qualifying health benefit plan.
234	234	Sec. 1508.154. REPORTS. A health benefit plan issuer that
235	235	participates in the program shall submit reports to the department
236	236	in the form and at the time the commissioner prescribes.
237	237	[Sections 1508.155-1508.200 reserved for expansion]
238	238	SUBCHAPTER E. RATING OF QUALIFIED HEALTH BENEFIT PLANS
239	239	Sec. 1508.201. RATING; PREMIUM PRACTICES IN GENERAL. (a) A
240	240	health benefit plan issuer participating in the program must:
241	241	(1) use rating practices for qualifying health benefit
242	242	plans that are consistent with the purposes of this chapter; and
243	243	(2) in setting premiums for qualifying health benefit
244	244	plans, consider the availability of reimbursement from the fund.
245	245	(b) A health benefit plan issuer participating in the
246	246	program shall apply rating factors consistently with respect to all
247	247	small employers in a class of business.
248	248	(c) Differences in premium rates charged for qualifying
249	249	health benefit plans must be reasonable and reflect objective
250	250	differences in plan design.
251	251	Sec. 1508.202. PREMIUM RATE DEVELOPMENT AND CALCULATION.
252	252	(a) Rating factors used to underwrite qualifying health benefit
253	253	plans must produce premium rates for identical groups that:
254	254	(1) differ only by the amounts attributable to health
255	255	benefit plan design; and
256	256	(2) do not reflect differences because of the nature
257	257	of the groups assumed to select a particular health benefit plan.
258	258	(b) A health benefit plan issuer shall treat each qualifying
259	259	health benefit plan that is issued or renewed in a calendar month as
260	260	having the same rating period.
261	261	(c) A health benefit plan issuer may use only age and gender
262	262	as case characteristics, as defined by Section 1501.201(2), in
263	263	setting premium rates for a qualifying health benefit plan.
264	264	(d) The commissioner by rule may establish additional
265	265	rating criteria and requirements for qualifying health benefit
266	266	plans if the commissioner determines that the criteria and
267	267	requirements are necessary to achieve the purposes of this chapter.
268	268	Sec. 1508.203. FILING; APPROVAL. (a) A health benefit plan
269	269	issuer shall file with the department, for review and approval by
270	270	the commissioner, premium rates to be charged for qualifying health
271	271	benefit plans.
272	272	(b) If the commissioner limits health benefit plan issuer
273	273	participation in the program under Section 1508.101(b), premium
274	274	rates proposed to be charged for each qualifying health benefit
275	275	plan will be considered as an element in the contract procurement
276	276	process required under that section.
277	277	[Sections 1508.204-1508.250 reserved for expansion]
278	278	SUBCHAPTER F. HEALTHY TEXAS SMALL EMPLOYER PREMIUM STABILIZATION
279	279	FUND
280	280	Sec. 1508.251. ESTABLISHMENT OF FUND. (a) To the extent
281	281	that funds appropriated to the department are available for this
282	282	purpose, the commissioner shall establish a fund from which health
283	283	benefit plan issuers may receive reimbursement for claims paid by
284	284	the health benefit plan issuers for individuals covered under
285	285	qualifying group health plans.
286	286	(b) The fund established under this section shall be known
287	287	as the healthy Texas small employer premium stabilization fund.
288	288	(c) The commissioner shall adopt rules necessary to
289	289	implement and administer the fund, including rules that set out the
290	290	procedures for operation of the fund and distribution of money from
291	291	the fund.
292	292	Sec. 1508.252. OPERATION OF FUND; CLAIM ELIGIBILITY. (a) A
293	293	health benefit plan issuer is eligible to receive reimbursement in
294	294	an amount that is equal to 80 percent of the dollar amount of claims
295	295	paid between $5,000 and $75,000 in a calendar year for an enrollee
296	296	in a qualifying health benefit plan.
297	297	(b) A health benefit plan issuer is eligible for
298	298	reimbursement from the fund only for the calendar year in which
299	299	claims are paid.
300	300	(c) Once the dollar amount of claims paid on behalf of a
301	301	covered individual reaches or exceeds $75,000 in a given calendar
302	302	year, a health benefit plan issuer may not receive reimbursement
303	303	for any other claims paid on behalf of the individual in that
304	304	calendar year.
305	305	Sec. 1508.253. REIMBURSEMENT REQUEST SUBMISSION. (a) A
306	306	health benefit plan issuer seeking reimbursement from the fund
307	307	shall submit a request for reimbursement in the form prescribed by
308	308	the commissioner by rule.
309	309	(b) A health benefit plan issuer must request reimbursement
310	310	from the fund annually, not later than the date determined by the
311	311	commissioner, following the end of the calendar year for which the
312	312	reimbursement requests are made.
313	313	(c) The commissioner may require a health benefit plan
314	314	issuer participating in the program to submit claims data in
315	315	connection with reimbursement requests as the commissioner
316	316	determines to be necessary to ensure appropriate distribution of
317	317	reimbursement funds and oversee the operation of the fund. The
318	318	commissioner may require that the data be submitted on a per covered
319	319	individual, aggregate, or categorical basis.
320	320	Sec. 1508.254. FUND AVAILABILITY. (a) The commissioner
321	321	shall compute the total claims reimbursement amount for all health
322	322	benefit plan issuers participating in the program for the calendar
323	323	year for which claims are reported and reimbursement requested.
324	324	(b) If the total amount requested by health benefit plan
325	325	issuers participating in the program for reimbursement for a
326	326	calendar year exceeds the amount of funds available for
327	327	distribution for claims paid during that same calendar year, the
328	328	commissioner shall provide for the pro rata distribution of any
329	329	available funds. A health benefit plan issuer participating in the
330	330	program is eligible to receive a proportional amount of any
331	331	available funds that is equal to the proportion of total eligible
332	332	claims paid by all participating health benefit plan issuers that
333	333	the requesting health benefit plan issuer paid.
334	334	(c) If the amount of funds available for distribution for
335	335	claims paid by all health benefit plan issuers participating in the
336	336	program during a calendar year exceeds the total amount requested
337	337	for reimbursement by all participating health benefit plan issuers
338	338	during that calendar year, the commissioner shall carry forward any
339	339	excess funds and make those excess funds available for distribution
340	340	in the next calendar year. Excess funds carried over under this
341	341	section are added to the fund in addition to any other money
342	342	appropriated for the fund for the calendar year into which the funds
343	343	are carried forward.
344	344	Sec. 1508.255. PROGRAM REPORTING. (a) Each health benefit
345	345	plan issuer participating in the program shall provide the
346	346	department, in the form prescribed by the commissioner, monthly
347	347	reports of total enrollment under qualifying health benefit plans.
348	348	(b) On the request of the commissioner, each health benefit
349	349	plan issuer participating in the program shall furnish to the
350	350	department, in the form prescribed by the commissioner, data other
351	351	than data described by Subsection (a) that the commissioner
352	352	determines necessary to oversee the operation of the fund.
353	353	Sec. 1508.256. CLAIMS EXPERIENCE DATA. (a) Based on
354	354	available data and appropriate actuarial assumptions, the
355	355	commissioner shall separately estimate the per covered individual
356	356	annual cost of total claims reimbursement from the fund for
357	357	qualifying health benefit plans.
358	358	(b) On request, a health benefit plan issuer participating
359	359	in the program shall furnish to the department claims experience
360	360	data for use in the estimates described by Subsection (a).
361	361	Sec. 1508.257. TOTAL ELIGIBLE ENROLLMENT DETERMINATION.
362	362	The commissioner shall determine total eligible enrollment under
363	363	qualifying health benefit plans by dividing the total funds
364	364	available for distribution from the fund by the estimated per
365	365	covered individual annual cost of total claims reimbursement from
366	366	the fund.
367	367	Sec. 1508.258. EVALUATION AND PROTECTION OF FUND; EMPLOYER
368	368	ENROLLMENT SUSPENSION. (a) The commissioner shall suspend the
369	369	enrollment of new employers in qualifying health benefit plans if
370	370	the commissioner determines that the total enrollment reported by
371	371	all health benefit plan issuers under qualifying health benefit
372	372	plans exceeds the total eligible enrollment determined under
373	373	Section 1508.257 and is likely to result in anticipated annual
374	374	expenditures from the fund in excess of the total funds available
375	375	for distribution from the fund.
376	376	(b) The commissioner shall provide a health benefit plan
377	377	issuer participating in the program with notification of any
378	378	enrollment suspension under Subsection (a) as soon as practicable
379	379	after:
380	380	(1) receipt of all enrollment data; and
381	381	(2) determination of the need to suspend enrollment.
382	382	(c) A suspension of issuance of qualifying health benefit
383	383	plans to employers under Subsection (a) does not preclude the
384	384	addition of new employees of an employer already covered under a
385	385	qualifying health benefit plan or new dependents of employees
386	386	already covered under a qualifying health benefit plan.
387	387	Sec. 1508.259. EMPLOYER ENROLLMENT REACTIVATION. If, at
388	388	any point during a suspension of enrollment under Section 1508.258,
389	389	the commissioner determines that funds are sufficient to provide
390	390	for the addition of new enrollments, the commissioner:
391	391	(1) may reactivate new enrollments; and
392	392	(2) shall notify all participating group health
393	393	benefit plan issuers that enrollment of new employers may be
394	394	resumed.
395	395	Sec. 1508.260. FUND ADMINISTRATOR. (a) The commissioner
396	396	may obtain the services of an independent organization to
397	397	administer the fund.
398	398	(b) The commissioner shall establish guidelines for the
399	399	submission of proposals by organizations for the purposes of
400	400	administering the fund and may approve, disapprove, or recommend
401	401	modification to the proposal of an applicant to administer the
402	402	fund.
403	403	(c) An organization approved to administer the fund shall
404	404	submit reports to the commissioner, in the form and at the times
405	405	required by the commissioner, as necessary to facilitate evaluation
406	406	and ensure orderly operation of the fund, including an annual
407	407	report of the affairs and operations of the fund. The annual report
408	408	must also be delivered to the governor, the lieutenant governor,
409	409	and the speaker of the house of representatives.
410	410	(d) An organization approved to administer the fund shall
411	411	maintain records in the form prescribed by the commissioner and
412	412	make those records available for inspection by or at the request of
413	413	the commissioner.
414	414	(e) The commissioner shall determine the amount of
415	415	compensation to be allocated to an approved organization as payment
416	416	for fund administration. Compensation is payable only from the
417	417	fund.
418	418	(f) The commissioner may remove an organization approved to
419	419	administer the fund from fund administration. An organization
420	420	removed from fund administration under this subsection must
421	421	cooperate in the orderly transition of services to another approved
422	422	organization or to the commissioner.
423	423	Sec. 1508.261. STOP-LOSS INSURANCE; REINSURANCE. (a) The
424	424	administrator of the fund, on behalf of and with the prior approval
425	425	of the commissioner, may purchase stop-loss insurance or
426	426	reinsurance from an insurance company licensed to write that
427	427	coverage in this state.
428	428	(b) Stop-loss insurance or reinsurance may be purchased to
429	429	the extent that the commissioner determines funds are available for
430	430	the purchase of that insurance.
431	431	Sec. 1508.262. PUBLIC EDUCATION AND OUTREACH. (a) The
432	432	commissioner may use an amount of the fund, not to exceed eight
433	433	percent of the annual amount of the fund, for purposes of developing
434	434	and implementing public education, outreach, and facilitated
435	435	enrollment strategies targeted to small employers who do not
436	436	provide health insurance.
437	437	(b) The commissioner may contract with marketing
438	438	organizations to perform or provide assistance with education,
439	439	outreach, and enrollment strategies described by Subsection (a).
440	440	SECTION 2. The commissioner of insurance shall adopt any
441	441	rules necessary to implement the change in law made by this Act not
442	442	later than January 4, 2010.
443	443	SECTION 3. (a) The commissioner of insurance shall make an
444	444	initial determination concerning limitation of health benefit plan
445	445	issuer participation in the program established under Chapter 1508,
446	446	Insurance Code, as added by this Act, not later than January 18,
447	447	2010. If the commissioner determines that limited participation is
448	448	necessary to achieve the purposes of Chapter 1508, Insurance Code,
449	449	as added by this Act, the commissioner shall issue a request for
450	450	proposal from health benefit plan issuers to participate in the
451	451	program not later than May 1, 2010.
452	452	(b) The commissioner shall ensure that the Healthy Texas
453	453	Program is fully operational in a manner that allows health benefit
454	454	plan issuers participating in the program to make the first annual
455	455	request for reimbursement on January 1, 2011.
456	456	SECTION 4. This Act takes effect September 1, 2009.