By: Zerwas H.B. No. 3791
A BILL TO BE ENTITLED
AN ACT
rel
ating to the creation of a "Texas" solution to issues related to
Medicaid, including flexibility in the administration of the
Medicaid program, tailored to the needs of the state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The legislature finds that:
a) Our current Texas Medicaid program has reached an
unsustainable capacity;
b) Texas stands to gain coverage for a significant number of
now uninsured residents through any healthcare expansion; and
c) The current Texas network of hospital and physician
providers cannot endure an expansion of patient need without
significant reform;
d) It is in the best interest of this state that the
Legislature and the Texas Health and Human Services Commission
negotiate a plan that considers the particular needs of Texas, our
economy, and unique population.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02105 to read as follows:
Sec. 531.02105. FLEXIBILITY FROM FEDERAL REQUIREMENTS. (a)
The commission shall negotiate with the United States secretary of
health and human services, the federal Centers for Medicare and
Medicaid Services, and other appropriate persons for flexibility to
adjust the operation of the Medicaid program without the necessity
of receiving federal approval for all changes to the program. Any
agreement reached must identify broad categories of:
(1) program changes that may be made without the need
for additional federal approval; and
(2) program changes that require additional federal
approval;
(b) In reaching an agreement, the commission shall ensure
that any agreement:
(1) allows the state flexibility from federal
requirements to develop a tailor insurance product for low-income
adults;
(2) allows any product to leverage private markets by
building on a managed care model and maximizing premium assistance
where cost effective to the state;
(3) allow the product to prioritize personal
responsibility by meaningful cost sharing requirements;
(4) benefits Texas taxpayers by providing appropriate
health care coverage, encourages appropriate health care
utilization in low-cost settings, provides meaningful tax relief at
the local level, and frees up general revenue to support other state
priorities.
(c) An agreement under this section may be limited in
duration and may be contingent on the continued funding obligations
of the federal government.
SECTION 3. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 539 to read as follows:
CHAPTER 539. ALTERNATIVE MEDICAID EXPANSION PROGRAMS
Sec. 539.001. FEDERAL AUTHORIZATION FOR ALTERNATIVE
MEDICAID EXPANSION PROGRAMS. In addition to the commission's
ability to negotiate under Section 531,02105, The commission shall
actively negotiate with the United States secretary of health and
human services, the federal Centers for Medicare and Medicaid
Services, and other appropriate persons for federal authorization
for the state to operate the component of the state Medicaid program
for providing program benefits to the Medicaid expansion population
under an alternative Medicaid expansion plan, including a block
grant funding system or state plan amendment.
Sec. 539.002. MINIMUM REQUIREMENTS OF FEDERAL
AUTHORIZATION. Federal authorization obtained under Section
539.001 must allow for providing state Medicaid program benefits to
recipients in the Medicaid expansion population under the same
terms and conditions as an agreement under Section 531.02105
Sec. 539.003. IMPLEMENTATION OF ALTERNATIVE MEDICAID
EXPANSION PLAN. If the commission receives the authorization
described by Section 539.002, the commission shall develop and
provide any appropriate state Medicaid program.
SECTION 4. The Health and Human Services Commission shall
actively develop a proposal for the authorization from the
appropriate federal entity as required by Section 531.02105 and
Chapter 539, Government Code, as added by this Act. As soon as
possible after the effective date of this Act, the Health and Human
Services Commission shall request and actively pursue obtaining the
authorization from the appropriate federal entity.
SECTION 5. (a) The Health and Human Services Commission,
the Texas Department of Insurance, or the commission in conjunction
with the department, shall negotiate with the appropriate federal
entity for authorization to develop any appropriate alternative
Medicaid expansion plan, including a state health benefit exchange.
The negotiated authorization must allow the state health benefit
exchange to be flexible, patient-friendly, tailored to the needs of
the state, and be similar to the health benefit exchange described
in the Patients' Choice Act, S.B. 516, 111th Congress (2009), or
H.R. 2520, 111th Congress (2009).
(b) If the appropriate federal entity authorizes an
alternative Medicaid expansion plan, including a state health
benefit exchange described in Subsection (a) of this section, the
Health and Human Services Commission, the Texas Department of
Insurance, or the commission in conjunction with the department,
shall develop and implement the health benefit exchange.
SECTION 6. Not later than September 1, 2013, the Speaker of
the House and the Lieutenant Governor shall each appoint a chair and
four additional members of their respective houses to advise the
Health and Human Services Commission and the Texas Department of
Insurance on negotiations with the federal government regarding
federal authorization for the state to operate the component of the
state Medicaid program for providing program benefits to the
Medicaid expansion population under an alternative Medicaid
expansion plan, including a block grant funding system or state
plan amendment.
SECTION 7. This Act takes effect immediately if it 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, this
Act takes effect September 1, 2013.