By: Averitt, et al. S.B. No. 841
Substitute the following for S.B. No. 841:
By: Rose C.S.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. Sections 62.101(b) and (b-1), Health and Safety
Code, are 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.
(b-1) The eligibility standards adopted under Subsection
(b) related to allowable assets:
(1) must allow a family to own at least $20,000
[$10,000] in allowable assets; and
(2) may not in calculating the amount of allowable
assets under Subdivision (1) consider:
(A) the value of one vehicle that qualifies for
an exemption under commission rule based on its use;
(B) the value of a second or subsequent vehicle
that qualifies for an exemption under commission rule based on its
use if:
(i) the vehicle is worth $18,000 or less; or
(ii) the vehicle has been modified to
provide transportation for a household member with a disability;
(C) if no vehicle qualifies for an exemption
based on its use under commission rule, the [first $18,000 of] value
of the highest valued vehicle; or
(D) the first $7,500 of value of any vehicle not
described by Paragraph (A), (B), or (C).
SECTION 2. 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 3. 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 approximately equal to
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 4. 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 5. 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) 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).
(b) The rules required by Subsection (a) 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 6. 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, but do not exceed 400 percent, of
the federal poverty level are eligible to purchase health benefits
coverage similar to 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, including a
requirement that a child must lack access to adequate health
benefits plan coverage through an employer-sponsored group health
benefits plan;
(2) ensure that premiums:
(A) are set at a level designed to cover the costs
of coverage for children participating in the buy-in option under
this subchapter; and
(B) progressively increase as the number of
children in the enrollee's family provided coverage increases;
(3) ensure that required premiums and costs for the
coverage for a child under this subchapter:
(A) are at least equal to the cost to the
commission of otherwise providing child health plan coverage,
including dental benefits, to another child who is the same age, and
who resides in the same state service delivery area, as the child
receiving coverage under this subchapter; and
(B) include:
(i) a fee in an amount determined by the
commission to offset all or part of the cost of prescription drugs
provided to enrollees under this subchapter;
(ii) fees to offset administrative costs
incurred under this subchapter; and
(iii) additional deductibles, coinsurance,
or other cost-sharing payments as determined by the executive
commissioner; and
(4) include an option for an enrollee to pay monthly
premiums using direct debits to bank accounts or credit cards.
(a-1) The rules adopted under Subsection (a)(1) must
provide that a child is eligible for health benefits coverage under
this subchapter only if the child was eligible for the medical
assistance program under Chapter 32, Human Resources Code, or the
child health plan program under Section 62.101 and was enrolled in
the applicable program, but the child's enrollment was not renewed
because, at the time of the eligibility redetermination, the
child's net family income exceeded the limit specified by Section
62.101.
(b) Notwithstanding any other provision of this chapter,
the executive commissioner may establish rules, benefit coverage,
and procedures for children for whom health benefits coverage is
purchased under this subchapter that differ from the rules, benefit
coverage, 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.
Sec. 62.254. POINT-OF-SERVICE COPAYMENT. The commission
shall establish point-of-service copayments for the buy-in option
developed under this subchapter that are higher than
point-of-service copayments required for a child whose net family
income is at or below 300 percent of the federal poverty level.
Sec. 62.255. LOCK-OUT. (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 re-enrolled in the
child health plan program.
(b) The commission shall include a lock-out period for the
buy-in option developed under this subchapter for the purpose of
providing a disincentive for a parent to drop a child's coverage
when a child is healthy and re-enroll only when health care needs
occur.
SECTION 7. 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 child care
expenses and child support payments, in accordance with standards
applicable under the Medicaid program.
SECTION 8. Subchapter C, Chapter 62, Health and Safety
Code, is amended by adding Section 62.1012 to read as follows:
Sec. 62.1012. EXCLUSION OF COLLEGE SAVINGS PLANS. For
purposes of determining whether a child meets family income and
resource requirements for eligibility for the child health plan,
the commission may not consider as income or resources a right to
assets held in or a right to receive payments or benefits under any
of the following:
(1) any fund or plan established under Subchapter F or
H, Chapter 54, Education Code, including an interest in a prepaid
tuition contract;
(2) any fund or plan established under Subchapter G,
Chapter 54, Education Code, including an interest in a savings
trust account;
(3) any qualified tuition program of any state that
meets the requirements of Section 529, Internal Revenue Code of
1986; or
(4) any taxable credit-only savings account that is
opened in a child's name and gifted to the child by a postsecondary
education awards program and that is exclusively accessible by the
program administrator.
SECTION 9. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0992 to read as follows:
Sec. 531.0992. COMMUNITY OUTREACH FOR THE CHILD HEALTH PLAN
PROGRAM. (a) The commission shall improve the effectiveness of
community outreach efforts with respect to the child health plan
program. To improve that effectiveness, the commission shall:
(1) increase the capacity of existing outreach efforts
implemented through community-based organizations by providing
those organizations with adequate resources to:
(A) educate the public about the child health
plan program;
(B) provide assistance to the public in
completing applications for eligibility or recertification of
eligibility and obtaining required documentation for applications;
and
(C) assist applicants in resolving problems
encountered during the eligibility determination process;
(2) establish a partnership with stakeholders who will
provide outreach and application assistance by:
(A) fostering the exchange of information
regarding, and promoting, best practices for obtaining health
benefits coverage for children;
(B) assisting the commission in designing and
implementing processes to reduce procedural denials; and
(C) disseminating successful outreach models
across this state under which entities such as hospitals, school
districts, and local businesses partner to identify children
without health benefits coverage; and
(3) focus the outreach efforts particularly on
enrolling eligible persons in the child health plan program.
(b) The partnership established under Subsection (b)(2)
must include entities that contract with the commission to perform
child health plan program eligibility determination and enrollment
functions, community-based organizations that contract with the
commission, health benefit plan providers, Texas Health Steps
program contractors, health care providers, consumer advocates,
and other interested stakeholders.
(c) The commission may also improve the effectiveness of
community outreach efforts with respect to the child health plan
program by contracting with one or more persons to provide outreach
and application assistance for the program. The commission shall
require each potential contractor under this subsection to indicate
the person's interest in writing before submitting a proposal for a
contract. If more than one person from a geographic area determined
by the commission submits a letter of interest, the commission
shall encourage the persons from that area to collaborate on a
proposal for a contract.
(d) To the extent practicable, the commission shall give
preference in awarding contracts under Subsection (d) to proposals
submitted by collaborations that include multiple entities with
experience in serving a variety of populations, including
populations that more commonly enroll in or receive benefits under
the child health plan program.
SECTION 10. Subchapter D, Chapter 62, Health and Safety
Code, is amended by adding Section 62.160 to read as follows:
Sec. 62.160. PROSPECTIVE PAYMENT SYSTEM FOR CERTAIN
SERVICES. (a) In this section:
(1) "Federally-qualified health center" has the
meaning assigned by Section 1905(l)(2)(B), Social Security Act (42
U.S.C. Section 1396d(l)(2)(B)).
(2) "Federally-qualified health center services" has
the meaning assigned by Section 1905(l)(2)(A), Social Security Act
(42 U.S.C. Section 1396d(l)(2)(A)).
(3) "Rural health clinic" and "rural health clinic
services" have the meanings assigned by Section 1905(l)(1), Social
Security Act (42 U.S.C. Section 1396d(l)(1)).
(b) The commission shall apply the prospective payment
system established under Section 1902(bb), Social Security Act (42
U.S.C. Section 1396a(bb)), in providing child health plan coverage
for rural health clinic services provided through rural health
clinics and federally-qualified health center services provided
through federally-qualified health centers in accordance with
Section 2107(e)(1), Social Security Act (42 U.S.C. Section
1397gg(e)(1)).
SECTION 11. Chapter 531, Government Code, is amended by
adding Subchapter M-1 to read as follows:
SUBCHAPTER M-1. ELIGIBILITY DETERMINATION STREAMLINING AND
IMPROVEMENT
Sec. 531.471. DEFINITIONS. In this subchapter:
(1) "SAVERR" means the System of Application,
Verification, Eligibility, Referral, and Reporting.
(2) "TIERS" means the Texas Integrated Eligibility
Redesign System.
Sec. 531.472. CORRECTIVE ACTION PLAN. If for three
consecutive months less than 90 percent of the applications or
eligibility recertifications for the child health plan program are
accurately processed through SAVERR or TIERS, or otherwise for the
child health plan program, within the applicable processing time
requirements established by state and federal law, the executive
commissioner by rule shall adopt a corrective action plan for the
child health plan program that:
(1) identifies the steps necessary to improve the
timeliness of application processing and the accuracy of
eligibility determinations; and
(2) to the extent possible within the staffing levels
authorized by the General Appropriations Act, ensures that child
health plan program eligibility determinations are accurately made
within applicable processing time requirements established by
state and federal law.
Sec. 531.473. REDUCTION OF DENIALS FOR MISSING INFORMATION.
(a) The executive commissioner by rule shall adopt processes
designed to reduce denials of eligibility for the child health plan
program due to information missing from an application. The
processes must include providing comprehensive information to an
applicant, enrollee, or recipient regarding acceptable
documentation of income for purposes of an eligibility
determination.
(b) Before imposing a denial of eligibility for the child
health plan program for failure to provide information needed to
complete an application, including an application for
recertification, the commission shall:
(1) attempt to contact the applicant, enrollee, or
recipient by telephone or mail to describe the specific information
that must be provided to complete the application; and
(2) allow the person a period of at least 10 business
days to provide the missing information instead of requiring the
person to submit a new application.
Sec. 531.474. CALL RESOLUTION STANDARDS. The executive
commissioner shall establish telephone call resolution standards
and processes for each call center established under Section
531.063, including a call center operated by a contractor, to
ensure that telephone calls regarding questions, issues, or
complaints received at call centers are accurately handled by call
center staff and are successfully resolved by call center or agency
staff.
SECTION 12. Sections 62.102(b) and (c) and 62.151(f),
Health and Safety Code, are repealed.
SECTION 13. Not later than January 1, 2010, 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 14. 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, made on or after September 1, 2009.
SECTION 15. 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 16. This Act takes effect September 1, 2009.