By: Nelson S.B. No. 1057
(In the Senate - Filed March 4, 2013; March 12, 2013, read
first time and referred to Committee on Health and Human Services;
March 28, 2013, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 9, Nays 0; March 28, 2013,
sent to printer.)
COMMITTEE SUBSTITUTE FOR S.B. No. 1057 By: Nelson
A BILL TO BE ENTITLED
AN ACT
relating to information about private health care insurance
coverage and the health insurance exchange for individuals applying
for certain Department of State Health Services health or mental
health benefits, services, and assistance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 1001, Health and Safety
Code, is amended by adding Sections 1001.080 and 1001.081 to read as
follows:
Sec. 1001.080. HEALTH INSURANCE COVERAGE INFORMATION.
(a) In this section, "individual's legally authorized
representative" means:
(1) a parent, managing conservator, or guardian of an
individual, if the individual is a minor;
(2) a guardian of an individual, if the individual has
been adjudicated incompetent to manage the individual's personal
affairs; or
(3) an agent of the individual authorized under a
durable power of attorney for health care.
(b) This section applies to health or mental health
benefits, services, or assistance provided by the department that
the department anticipates will be impacted by a health insurance
exchange as defined by Section 1001.081(a), including:
(1) community primary health care services provided
under Chapter 31;
(2) women's and children's health services provided
under Chapter 32;
(3) services for children with special health care
needs provided under Chapter 35;
(4) epilepsy program assistance provided under
Chapter 40;
(5) hemophilia program assistance provided under
Chapter 41;
(6) kidney health care services provided under Chapter
42;
(7) human immunodeficiency virus infection and
sexually transmitted disease prevention programs and services
provided under Chapter 85;
(8) immunization programs provided under Chapter 161;
(9) programs and services provided by the Rio Grande
State Center under Chapter 252;
(10) mental health services for adults provided under
Chapter 534;
(11) mental health services for children provided
under Chapter 534;
(12) the NorthSTAR Behavioral Health Program provided
under Chapter 534;
(13) programs and services provided by community
mental health hospitals under Chapter 552;
(14) programs and services provided by state mental
health hospitals under Chapter 552; and
(15) any other health or mental health program or
service designated by the department.
(c) Subject to Subsection (d), the department may not
provide health or mental health benefits, services, or assistance
described in Subsection (b) unless the individual applying to
receive the benefits, services, or assistance submits to the
department on the form prescribed by the department:
(1) a statement by the individual or the individual's
legally authorized representative attesting that the individual
does not have access to private health care insurance that provides
coverage for the benefit, service, or assistance; or
(2) if the individual has access to private health
care insurance that provides coverage for the benefit, service, or
assistance, the information and authorization necessary for the
department to submit a claim for reimbursement from the insurer for
the benefit, service, or assistance.
(d) The department may waive the prohibition under
Subsection (c) for an individual or for health or mental health
benefits, services, or assistance described in Subsection (b) if
the department determines that a benefit, service, or assistance is
necessary during a crisis or emergency.
(e) The executive commissioner shall adopt rules necessary
to implement this section.
Sec. 1001.081. HEALTH INSURANCE EXCHANGE INFORMATION.
(a) In this section:
(1) "Health insurance exchange" means an American
Health Benefit Exchange administered by the federal government
under 42 U.S.C. Section 18041 or created under 42 U.S.C. Section
18031.
(2) "Individual's legally authorized representative"
has the meaning assigned by Section 1001.080(a).
(b) The department may develop informational materials
regarding health care insurance coverage and subsidies available
under a health insurance exchange.
(c) The department shall provide the informational
materials regarding health care insurance coverage and subsidies
available under a health insurance exchange to an individual or the
individual's legally authorized representative who:
(1) applies to receive health or mental health
benefits, services, or assistance described in Section
1001.080(b); and
(2) has an income above 100 percent of the federal
poverty level.
(d) The executive commissioner shall adopt rules necessary
to implement this section.
SECTION 2. As soon as practicable after the effective date
of this Act, the Department of State Health Services shall
prescribe the form required by Section 1001.080, Health and Safety
Code, as added by this Act.
SECTION 3. As soon as possible after the effective date of
this Act, the Health and Human Services Commission shall apply for
any waiver or other authorization necessary to implement this Act.
The commission may delay implementing this Act until the waiver or
authorization is granted.
SECTION 4. 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.
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