By: Averitt, et al. S.B. No. 841
A BILL TO BE ENTITLED
AN ACT
relating to the child health plan program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subdivision (2), Section 62.002, Health and
Safety Code, is 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].
SECTION 2. Subsection (b), Section 62.101, 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 250 [150] percent of the
federal poverty level.
SECTION 3. Subsections (b) and (c), Section 62.102, Health
and Safety Code, are amended to read as follows:
(b) During the sixth month following the date of initial
enrollment or reenrollment of an individual whose net family income
exceeds 285 [185] percent of the federal poverty level, the
commission shall:
(1) review the individual's net family income and may
use electronic technology if available and appropriate; and
(2) continue to provide coverage if the individual's
net family income does not exceed the income eligibility limits
prescribed by Section 62.101 [this chapter].
(c) If, during the review required under Subsection (b), the
commission determines that the individual's net family income
exceeds the income eligibility limits prescribed by Section 62.101
[this chapter], the commission may not disenroll the individual
until:
(1) the commission has provided the family an
opportunity to demonstrate that the family's net family income is
within the income eligibility limits prescribed by Section 62.101
[this chapter]; and
(2) the family fails to demonstrate such eligibility.
SECTION 4. Section 62.151, Health and Safety Code, is
amended by adding Subsection (g) to read as follows:
(g) In developing the plan, the commission, subject to
federal requirements, may choose to provide dental benefits at full
cost to the enrollee as an available plan option for a child whose
net family income is greater than 200 percent but not greater than
300 percent of the federal poverty level.
SECTION 5. Section 62.153, Health and Safety Code, is
amended by amending Subsections (a) and (c) and adding Subsections
(a-1) and (a-2) to read as follows:
(a) To the extent permitted under 42 U.S.C. Section 1397cc,
as amended, and any other applicable law or regulations, the
commission shall require enrollees whose net family incomes are at
or below 200 percent of the federal poverty level to share the cost
of the child health plan, including provisions requiring enrollees
under the child health plan to pay:
(1) a copayment for services provided under the plan;
(2) an enrollment fee; or
(3) a portion of the plan premium.
(a-1) The commission shall require enrollees whose net
family incomes are greater than 200 percent but not greater than 300
percent of the federal poverty level to pay a share of the cost of
the child health plan through copayments, fees, and a portion of the
plan premium. The total amount of the share required to be paid
must:
(1) include a portion of the plan premium set at an
amount determined by the commission that is not more than 2.5
percent of an enrollee's net family income;
(2) exceed the amount required to be paid by enrollees
described by Subsection (a), but the total amount required to be
paid may not exceed five percent of an enrollee's net family income;
and
(3) increase incrementally, as determined by the
commission, as an enrollee's net family income increases.
(a-2) In establishing the cost required to be paid by an
enrollee described by Subsection (a-1) as a portion of the plan
premium, the commission shall ensure that the cost progressively
increases as the number of children in the enrollee's family
provided coverage increases.
(c) The [If cost-sharing provisions imposed under
Subsection (a) include requirements that enrollees pay a portion of
the plan premium, the] commission shall specify the manner of
payment for any portion of the plan premium required to be paid by
an enrollee under this section [in which the premium is paid]. The
commission may require that the premium be paid to the [Texas
Department of] Health and Human Services Commission, the [Texas]
Department of State Health [Human] Services, or the health plan
provider. The commission shall develop an option for an enrollee to
pay monthly premiums using direct debits to bank accounts or credit
cards.
SECTION 6. Section 62.154, Health and Safety Code, is
amended by amending Subsection (d) and adding Subsection (e) to
read as follows:
(d) The waiting period required by Subsection (a) for a
child whose net family income is at or below 200 percent of the
federal poverty level must:
(1) extend for a period of 90 days after the last date
on which the applicant was covered under a health benefits plan; and
(2) apply to a child who was covered by a health
benefits plan at any time during the 90 days before the date of
application for coverage under the child health plan.
(e) The waiting period required by Subsection (a) for a
child whose net family income is greater than 200 percent but not
greater than 300 percent of the federal poverty level must:
(1) extend for a period of 180 days after the last
date on which the applicant was covered under a health benefits
plan; and
(2) apply to a child who was covered by a health
benefits plan at any time during the 180 days before the date of
application for coverage under the child health plan.
SECTION 7. Subchapter D, Chapter 62, Health and Safety
Code, is amended by adding Section 62.1551 to read as follows:
Sec. 62.1551. TERMINATION OF COVERAGE FOR NONPAYMENT OF
PREMIUMS. (a) In this section, "lock-out period" means a period
after coverage is terminated for nonpayment of premiums during
which a child may not be reenrolled in the child health plan
program.
(b) The executive commissioner by rule shall establish a
process that allows for the termination of coverage under the child
health plan of an enrollee whose net family income is greater than
200 percent but not greater than 300 percent of the federal poverty
level if the enrollee does not pay the premiums required under
Section 62.153(a-1).
(c) The rules required by Subsection (b) must:
(1) address the number of payments that may be missed
before coverage terminates;
(2) address the process for notifying an enrollee of
pending coverage termination; and
(3) provide for an appropriate lock-out period after
termination for nonpayment.
SECTION 8. 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 9. This Act does not make an appropriation. This
Act takes effect only if a specific appropriation for the
implementation of the Act is provided in a general appropriations
act of the 81st Legislature.
SECTION 10. This Act takes effect September 1, 2009.