By: Deuell S.B. No. 1477
A BILL TO BE ENTITLED
AN ACT
relating to flexibility in the administration of the Medicaid
program, a block grant funding approach to Medicaid expansion, and
the establishment of a health benefit exchange tailored to the
needs of the state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02105 to read as follows:
Sec. 531.02105. FLEXIBILITY FROM FEDERAL REQUIREMENTS. 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.
SECTION 2. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 539 to read as follows:
CHAPTER 539. BLOCK GRANT PROGRAM FOR MEDICAID EXPANSION POPULATION
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 539.001. DEFINITIONS. In this chapter:
(1) "Health benefit exchange" means an American Health
Benefit Exchange administered by the federal government, an
exchange created pursuant to Section 1311(b) of the Patient
Protection and Affordable Care Act (42 U.S.C. Section 18031(b)), or
a federally-authorized alternative state exchange.
(2) "Medicaid expansion population" means the
category of persons who would not be eligible for medical
assistance under the eligibility criteria in effect on December 31,
2013, but for whom federal matching funds are available under the
Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
amended by the Health Care Affordable Care Act of 2010 (Pub. L. No.
111-152) to provide that assistance.
(3) "Medicaid program" means the medical assistance
program established and operated under Title XIX of the federal
Social Security Act (42 U.S.C. Section 1396 et seq.).
(4) "State Medicaid program" means the medical
assistance program operated by this state as part of the Medicaid
program.
Sec. 539.002. CONFLICT WITH OTHER LAW. To the extent of a
conflict between a provision of this chapter and another state law,
the provision of this chapter controls.
SUBCHAPTER B. MEDICAID EXPANSION POPULATION PROGRAM REQUIREMENTS
Sec. 539.051. FEDERAL AUTHORIZATION FOR BLOCK GRANT SYSTEM.
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 a block grant funding system.
Sec. 539.052. MINIMUM REQUIREMENTS OF FEDERAL
AUTHORIZATION. (a) Federal authorization obtained under Section
539.051 must allow for providing state Medicaid program benefits to
recipients in the Medicaid expansion population in the form of
premium assistance so private health benefit coverage may be
obtained through a health benefit exchange.
(b) The authorization negotiated as provided by Section
539.051 must also allow for the provision of state Medicaid program
benefits to recipients in the Medicaid expansion population in a
manner that:
(1) encourages the use of private health benefit
coverage obtained through a health benefit exchange rather than
public benefits systems by providing premium assistance;
(2) creates customized health benefit plans for
certain defined populations within the Medicaid expansion group;
(3) encourages individuals who have access to private
employer-based health benefit coverage to obtain or maintain that
coverage;
(4) includes cost-sharing provisions that require a
recipient to be responsible for the payment of some premiums,
copayments, and deductibles in amounts not to exceed five percent
of a recipient's income;
(5) establishes wellness initiatives;
(6) encourages healthy lifestyles by adjusting
copayments and deductibles based on certain health risk factors;
(7) requires each recipient to undergo an annual
physical examination with a primary care physician;
(8) requires each recipient to lock into one primary
care physician who will coordinate patient care, including the need
for diagnostic testing, treatments, and referrals to specialists;
(9) contains work requirements for recipients, with
exceptions for recipients who are disabled, caretakers of disabled
family members, or caretakers of young children who are not of
school age; and
(10) requires that health benefit plans for recipients
to be issued on a guaranteed issue basis.
Sec. 539.053. IMPLEMENTATION OF BLOCK GRANT SYSTEM. (a) If
the commission receives the authorization described by Section
539.052, the commission shall provide state Medicaid program
benefits to all persons in the Medicaid expansion population who
apply and are determined eligible for the assistance.
(b) The commission shall:
(1) provide state Medicaid program benefits to persons
in the Medicaid expansion population in the manner allowed under
the authorization; and
(2) may not provide benefits to those persons under
any fee-for-service or managed care delivery model or arrangement
used to provide benefits to recipients who are not in the Medicaid
expansion population.
SUBCHAPTER C. FUNDING REDUCTIONS
Sec. 539.101. APPROPRIATIONS REDUCTIONS. The commission
shall ensure that legislative appropriations requests for the
commission and health and human services agencies reflect
reductions in the appropriated amounts needed to provide indigent
health care services that result from the program implemented under
this chapter.
SECTION 3. The Health and Human Services Commission shall
actively develop a proposal for the authorization from the
appropriate federal entity as required by 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 4. (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 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 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 5. 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.