By: Nelson, Lucio S.B. No. 66
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. Subsection (b), Section 154.182, 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 the laws of this state.
(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).
(5) "Third-party administrator" means a person who is
not a health benefit plan issuer or agent of a health benefit plan
issuer and who provides administrative services for the program,
including processing enrollment of eligible children in the program
and processing premium payments on behalf of the program.
(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 under Section
154.182(b)(1) or under Section 154.182(b)(2) from a source other
than the program.
(c) The director of the Title IV-D agency may establish an
advisory committee to consult with the director regarding the
implementation and operation of the program. If the director
establishes an advisory committee, the director may appoint any of
the following persons to the advisory committee:
(1) representatives of appropriate public and private
entities, including state agencies concerned with health care
management;
(2) members of the judiciary;
(3) members of the legislature; and
(4) representatives of the insurance industry.
(d) The principal objective of the program is to provide
basic health care services, including office visits with health
care providers, hospitalization, and diagnostic 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.
(e) The Title IV-D agency may use available private
resources, including gifts and grants, in administering the
program.
(f) The Title IV-D agency shall adopt rules as necessary to
implement the program. The Title IV-D agency shall consult with the
Texas Department of Insurance and the Health and Human Services
Commission in establishing policies and procedures for the
administration of the program and in determining appropriate
benefits to be provided under the program.
(g) A health benefit plan issuer that participates in the
program may not deny health care coverage under the program to
eligible children because of preexisting conditions or chronic
illnesses. 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. Enrollment of a child in the program does not preclude the
subsequent enrollment of the child in another health care plan that
becomes available to the child's parent at reasonable cost,
including a health care plan available through the parent's
employment or the state child health plan under Chapter 62, Health
and Safety Code.
(h) The Title IV-D agency shall contract with an independent
third-party administrator to provide necessary administrative
services for operation of the program.
(i) A person acting as a third-party administrator under
Subsection (h) is not considered an administrator for purposes of
Chapter 4151, Insurance Code.
(j) The Title IV-D agency shall solicit applications for
participation in the program from health benefit plan issuers that
meet requirements specified by the agency. Each health benefit
plan issuer that participates in the program must hold a
certificate of authority issued by the Texas Department of
Insurance.
(k) 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.
(l) On or after the date specified in the notification
required by Subsection (k), 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
health insurance is available for the child at reasonable cost,
including the state child health plan under Chapter 62, Health and
Safety Code.
(m) Payment of premium costs for the enrollment of a child
in the program may be enforced by the Title IV-D agency against the
obligor by any means available for the enforcement of a child
support obligation, including income withholding under Chapter
158.
(n) The program is not subject to any provision of the
Insurance Code or other law that requires coverage or the offer of
coverage of a health care service or benefit.
(o) Any health information obtained by the program, or by a
third-party administrator providing program services, that is
subject to the Health Insurance Portability and Accountability Act
of 1996 (42 U.S.C. Section 1320d et seq.) or Chapter 181, Health and
Safety Code, is confidential and not open to public inspection. Any
personally identifiable financial information or supporting
documentation of a parent whose child is enrolled in the program
that is obtained by the program, or by a third-party administrator
providing program services, is confidential and not open to public
inspection.
Sec. 154.1827. ADMINISTRATIVE ADJUSTMENT OF MEDICAL
SUPPORT ORDER. (a) In each 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 on an annual basis
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 of this Act takes effect September 1, 2009.