Texas 2015 - 84th Regular

Texas House Bill HB3845 Compare Versions

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1	1	By: Coleman H.B. No. 3845
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to a "Texas Way" to reforming and addressing issues
7	7	related to the Medicaid program, including the creation of an
8	8	alternative program designed to ensure health benefit plan coverage
9	9	to certain low-income individuals through the private marketplace;
10	10	authorizing a fee.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	ARTICLE 1. LEGISLATIVE INTENT
13	13	SECTION 1.01. (a) The legislature finds that:
14	14	(1) over a million citizens of this state fall into a
15	15	health care coverage gap because they cannot qualify for Medicaid
16	16	in this state but do not earn enough to qualify for federal tax
17	17	credits that are available to assist those citizens with purchasing
18	18	health benefit plan coverage through the private marketplace;
19	19	(2) it is imperative that this state act to ensure that
20	20	these citizens no longer fall through the health care coverage gap;
21	21	and
22	22	(3) this state should seek to address the unique
23	23	health care needs of our citizens in the same way other states,
24	24	including Indiana and Arkansas, have addressed the health care
25	25	needs of their citizens.
26	26	(b) The legislative intent of this Act is to propose a
27	27	"Texas Way" to closing the health care coverage gap that allows this
28	28	state flexibility in addressing the needs of its citizens in a way
29	29	that will make the private marketplace accessible to uninsured
30	30	citizens of this state, promote personal responsibility,
31	31	effectively utilize this state's health care resources, reduce
32	32	expensive emergency room care, and protect citizens of this state
33	33	currently insured through the private marketplace from potentially
34	34	losing their federal tax credits.
35	35	ARTICLE 2. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
36	36	SECTION 2.01. Subtitle I, Title 4, Government Code, is
37	37	amended by adding Chapter 540 to read as follows:
38	38	CHAPTER 540. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
39	39	SUBCHAPTER A. GENERAL PROVISIONS
40	40	Sec. 540.001. DEFINITIONS. In this chapter:
41	41	(1) "Health benefit exchange" means an American Health
42	42	Benefit Exchange administered by the federal government or an
43	43	exchange created under Section 1311(b) of the Patient Protection
44	44	and Affordable Care Act (42 U.S.C. Section 18031(b)).
45	45	(2) "Medicaid program" means the medical assistance
46	46	program established and operated under Title XIX, Social Security
47	47	Act (42 U.S.C. Section 1396 et seq.).
48	48	(3) "State Medicaid program" means the medical
49	49	assistance program provided by this state under the Medicaid
50	50	program.
51	51	Sec. 540.002. FEDERAL AUTHORIZATION TO REFORM MEDICAID
52	52	REQUIRED. If the federal government establishes, through
53	53	conversion or otherwise, a block grant funding system for the
54	54	Medicaid program or otherwise authorizes the state Medicaid program
55	55	to operate under a block grant funding system, including under a
56	56	Medicaid program waiver, the commission, in cooperation with
57	57	applicable health and human services agencies, shall, subject to
58	58	Section 540.003, administer and operate the state Medicaid program
59	59	in accordance with this chapter.
60	60	Sec. 540.003. CONFLICT WITH OTHER LAW. To the extent of a
61	61	conflict between a provision of this chapter and:
62	62	(1) another provision of state law, the provision of
63	63	this chapter controls, subject to Section 541.002(b); and
64	64	(2) a provision of federal law or any authorization
65	65	described under Section 540.002, the federal law or authorization
66	66	controls.
67	67	Sec. 540.004. ESTABLISHMENT OF REFORMED STATE MEDICAID
68	68	PROGRAM. The commission shall establish a state Medicaid program
69	69	that provides benefits under a risk-based Medicaid managed care
70	70	model.
71	71	Sec. 540.005. RULES. The executive commissioner shall
72	72	adopt rules necessary to implement this chapter.
73	73	SUBCHAPTER B. ACUTE CARE
74	74	Sec. 540.051. ELIGIBILITY FOR MEDICAID ACUTE CARE. (a) An
75	75	individual is eligible to receive acute care benefits under the
76	76	state Medicaid program if the individual:
77	77	(1) has a household income at or below 100 percent of
78	78	the federal poverty level;
79	79	(2) is under 19 years of age and:
80	80	(A) is receiving Supplemental Security Income
81	81	(SSI) under 42 U.S.C. Section 1381 et seq.; or
82	82	(B) is in foster care or resides in another
83	83	residential care setting under the conservatorship of the
84	84	Department of Family and Protective Services; or
85	85	(3) meets the eligibility requirements that were in
86	86	effect on September 1, 2013.
87	87	(b) The commission shall provide acute care benefits under
88	88	the state Medicaid program to each individual eligible under this
89	89	section through the most cost-effective means, as determined by the
90	90	commission.
91	91	(c) If an individual is not eligible for the state Medicaid
92	92	program under Subsection (a), the commission shall refer the
93	93	individual to the program established under Chapter 541 that helps
94	94	connect eligible residents with health benefit plan coverage
95	95	through private market solutions, a health benefit exchange, or any
96	96	other resource the commission determines appropriate.
97	97	Sec. 540.052. MEDICAID SLIDING SCALE SUBSIDIES. (a) An
98	98	individual who is eligible for the state Medicaid program under
99	99	Section 540.051 may receive a Medicaid sliding scale subsidy to
100	100	purchase a health benefit plan from an authorized health benefit
101	101	plan issuer.
102	102	(b) A sliding scale subsidy provided to an individual under
103	103	this section must:
104	104	(1) be based on:
105	105	(A) the average premium in the market; and
106	106	(B) a realistic assessment of the individual's
107	107	ability to pay a portion of the premium; and
108	108	(2) include an enhancement for individuals who choose
109	109	a high deductible health plan with a health savings account.
110	110	(c) The commission shall ensure that counselors are made
111	111	available to individuals receiving a subsidy to advise the
112	112	individuals on selecting a health benefit plan that meets the
113	113	individuals' needs.
114	114	(d) An individual receiving a subsidy under this section is
115	115	responsible for paying:
116	116	(1) any difference between the premium costs
117	117	associated with the purchase of a health benefit plan and the amount
118	118	of the individual's subsidy under this section; and
119	119	(2) any copayments associated with the health benefit
120	120	plan.
121	121	(e) If the amount of a subsidy received by an individual
122	122	under this section exceeds the premium costs associated with the
123	123	individual's purchase of a health benefit plan, the individual may
124	124	deposit the excess amount in a health savings account that may be
125	125	used only in the manner described by Section 540.054(b).
126	126	Sec. 540.053. ADDITIONAL COST-SHARING SUBSIDIES. In
127	127	addition to providing a subsidy to an individual under Section
128	128	540.052, the commission shall provide additional subsidies for
129	129	coinsurance payments, copayments, deductibles, and other
130	130	cost-sharing requirements associated with the individual's health
131	131	benefit plan. The commission shall provide the additional
132	132	subsidies on a sliding scale based on income.
133	133	Sec. 540.054. DELIVERY OF SUBSIDIES; HEALTH SAVINGS
134	134	ACCOUNTS. (a) The commission shall determine the most appropriate
135	135	manner for delivering and administering subsidies provided under
136	136	Sections 540.052 and 540.053. In determining the most appropriate
137	137	manner, the commission shall consider depositing subsidy amounts
138	138	for an individual in a health savings account established for that
139	139	individual.
140	140	(b) A health savings account established under this section
141	141	may be used only to:
142	142	(1) pay health benefit plan premiums and cost-sharing
143	143	amounts; and
144	144	(2) if appropriate, purchase health care-related
145	145	goods and services.
146	146	Sec. 540.055. MEDICAID HEALTH BENEFIT PLAN ISSUERS AND
147	147	MINIMUM COVERAGE. The commission shall allow any health benefit
148	148	plan issuer authorized to write health benefit plans in this state
149	149	to participate in the state Medicaid program. The commission in
150	150	consultation with the commissioner of insurance shall establish
151	151	minimum coverage requirements for a health benefit plan to be
152	152	eligible for purchase under the state Medicaid program, subject to
153	153	the requirements specified by this chapter.
154	154	Sec. 540.056. REINSURANCE FOR PARTICIPATING HEALTH BENEFIT
155	155	PLAN ISSUERS. (a) The commission in consultation with the
156	156	commissioner of insurance shall study a reinsurance program to
157	157	reinsure participating health benefit plan issuers.
158	158	(b) In examining options for a reinsurance program, the
159	159	commission and commissioner of insurance shall consider a plan
160	160	design under which:
161	161	(1) a participating health benefit plan is not charged
162	162	a premium for the reinsurance; and
163	163	(2) the health benefit plan issuer retains risk on a
164	164	sliding scale.
165	165	SUBCHAPTER C. LONG-TERM SERVICES AND SUPPORTS
166	166	Sec. 540.101. PLAN TO REFORM DELIVERY OF LONG-TERM SERVICES
167	167	AND SUPPORTS. The commission shall develop a comprehensive plan to
168	168	reform the delivery of long-term services and supports that is
169	169	designed to achieve the following objectives under the state
170	170	Medicaid program or any other program created as an alternative to
171	171	the state Medicaid program:
172	172	(1) encourage consumer direction;
173	173	(2) simplify and streamline the provision of services;
174	174	(3) provide flexibility to design benefits packages
175	175	that meet the needs of individuals receiving long-term services and
176	176	supports under the program;
177	177	(4) improve the cost-effectiveness and sustainability
178	178	of the provision of long-term services and supports;
179	179	(5) reduce reliance on institutional settings; and
180	180	(6) encourage cost sharing by family members when
181	181	appropriate.
182	182	ARTICLE 3. IMMEDIATE REFORM: PROGRAM TO ENSURE HEALTH BENEFIT
183	183	COVERAGE FOR CERTAIN INDIVIDUALS THROUGH PRIVATE MARKETPLACE
184	184	SECTION 3.01. Subtitle I, Title 4, Government Code, is
185	185	amended by adding Chapter 541 to read as follows:
186	186	CHAPTER 541. PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR
187	187	CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS
188	188	SUBCHAPTER A. GENERAL PROVISIONS
189	189	Sec. 541.001. DEFINITION. In this chapter, "medical
190	190	assistance program" means the program established under Chapter 32,
191	191	Human Resources Code.
192	192	Sec. 541.002. CONFLICT WITH OTHER LAW. (a) Except as
193	193	provided by Subsection (b), to the extent of a conflict between a
194	194	provision of this chapter and:
195	195	(1) another provision of state law, the provision of
196	196	this chapter controls; and
197	197	(2) a provision of federal law or any authorization
198	198	described under Subchapter B, the federal law or authorization
199	199	controls.
200	200	(b) The program operated under this chapter is in addition
201	201	to any medical assistance program operated under a block grant
202	202	funding system under Chapter 540.
203	203	Sec. 541.003. PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE
204	204	THROUGH PRIVATE MARKET SOLUTIONS. Subject to the requirements of
205	205	this chapter, the commission in consultation with the Texas
206	206	Department of Insurance shall develop and implement a program that
207	207	helps connect certain low-income residents of this state with
208	208	health benefit plan coverage through private market solutions.
209	209	Sec. 541.004. NOT AN ENTITLEMENT. This chapter does not
210	210	establish an entitlement to assistance in obtaining health benefit
211	211	plan coverage.
212	212	Sec. 541.005. RULES. The executive commissioner shall
213	213	adopt rules necessary to implement this chapter.
214	214	SUBCHAPTER B. FEDERAL AUTHORIZATION
215	215	Sec. 541.051. FEDERAL AUTHORIZATION FOR FLEXIBILITY TO
216	216	ESTABLISH PROGRAM. (a) The commission in consultation with the
217	217	Texas Department of Insurance shall negotiate with the United
218	218	States secretary of health and human services, the federal Centers
219	219	for Medicare and Medicaid Services, and other appropriate persons
220	220	for purposes of seeking a waiver or other authorization necessary
221	221	to obtain the flexibility to use federal matching funds to help
222	222	provide, in accordance with Subchapter C, health benefit plan
223	223	coverage to certain low-income individuals through private market
224	224	solutions.
225	225	(b) Any agreement reached under this section must:
226	226	(1) create a program that is made cost neutral to this
227	227	state by:
228	228	(A) leveraging premium tax revenues; and
229	229	(B) achieving cost savings through offsets to
230	230	general revenue health care costs or the implementation of other
231	231	cost savings mechanisms;
232	232	(2) create more efficient health benefit plan coverage
233	233	options for eligible individuals through:
234	234	(A) program changes that may be made without the
235	235	need for additional federal approval; and
236	236	(B) program changes that require additional
237	237	federal approval;
238	238	(3) require the commission to achieve efficiency and
239	239	reduce unnecessary utilization, including duplication, of health
240	240	care services;
241	241	(4) be designed with the goals of:
242	242	(A) relieving local tax burdens;
243	243	(B) reducing general revenue reliance so as to
244	244	make general revenue available for other state priorities; and
245	245	(C) minimizing the impact of any federal health
246	246	care laws on Texas-based businesses; and
247	247	(5) afford this state the opportunity to develop a
248	248	state-specific way with benefits that specifically meet the unique
249	249	needs of this state's population.
250	250	(c) An agreement reached under this section may be:
251	251	(1) limited in duration; and
252	252	(2) contingent on continued funding by the federal
253	253	government.
254	254	SUBCHAPTER C. PROGRAM REQUIREMENTS
255	255	Sec. 541.101. ENROLLMENT ELIGIBILITY. (a) Subject to
256	256	Subsection (b), an individual may be eligible to enroll in a program
257	257	designed and established under this chapter if the person:
258	258	(1) is younger than 65;
259	259	(2) has a household income at or below 133 percent of
260	260	the federal poverty level; and
261	261	(3) is not otherwise eligible to receive benefits
262	262	under the medical assistance program, including through a program
263	263	operated under Chapter 540 through a block grant funding system or a
264	264	waiver, other than one granted under this chapter, to the program.
265	265	(b) The executive commissioner may amend or further define
266	266	the eligibility requirements of this section if the commission
267	267	determines it necessary to reach an agreement under Subchapter B.
268	268	Sec. 541.102. MINIMUM PROGRAM REQUIREMENTS. A program
269	269	designed and established under this chapter must:
270	270	(1) if cost-effective for this state, provide premium
271	271	assistance to purchase health benefit plan coverage in the private
272	272	market, including health benefit plan coverage offered through a
273	273	managed care delivery model;
274	274	(2) provide enrollees with access to health benefits,
275	275	including benefits provided through a managed care delivery model,
276	276	that:
277	277	(A) are tailored to the enrollees;
278	278	(B) provide levels of coverage that are
279	279	customized to meet health care needs of individuals within defined
280	280	categories of the enrolled population; and
281	281	(C) emphasize personal responsibility and
282	282	accountability through flexible and meaningful cost-sharing
283	283	requirements and wellness initiatives, including through
284	284	incentives for compliance with health, wellness, and treatment
285	285	strategies and disincentives for noncompliance;
286	286	(3) include pay-for-performance initiatives for
287	287	private health benefit plan issuers that participate in the
288	288	program;
289	289	(4) use technology to maximize the efficiency with
290	290	which the commission and any health benefit plan issuer, health
291	291	care provider, or managed care organization participating in the
292	292	program manages enrollee participation;
293	293	(5) allow recipients under the medical assistance
294	294	program to enroll in the program to receive premium assistance as an
295	295	alternative to the medical assistance program;
296	296	(6) encourage eligible individuals to enroll in other
297	297	private or employer-sponsored health benefit plan coverage, if
298	298	available and appropriate;
299	299	(7) encourage the utilization of health care services
300	300	in the most appropriate low-cost settings; and
301	301	(8) establish health savings accounts for enrollees,
302	302	as appropriate.
303	303	SECTION 3.02. The Health and Human Services Commission in
304	304	consultation with the Texas Department of Insurance and the
305	305	Medicaid Reform Task Force shall actively develop a proposal for
306	306	the authorization from the appropriate federal entity as required
307	307	by Subchapter B, Chapter 541, Government Code, as added by this
308	308	article. As soon as possible after the effective date of this Act,
309	309	the Health and Human Services Commission shall request and actively
310	310	pursue obtaining the authorization from the appropriate federal
311	311	entity.
312	312	ARTICLE 4. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
313	313	SECTION 6.01. Subject to Section 3.02 of this Act, if before
314	314	implementing any provision of this Act a state agency determines
315	315	that a waiver or authorization from a federal agency is necessary
316	316	for implementation of that provision, the agency affected by the
317	317	provision shall request the waiver or authorization and may delay
318	318	implementing that provision until the waiver or authorization is
319	319	granted.
320	320	SECTION 6.02. This Act takes effect September 1, 2015.