Texas 2015 - 84th Regular

Texas House Bill HB4054 Compare Versions

Only one version of the bill is available at this time.

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1	1	By: Martinez Fischer H.B. No. 4054
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to a "Texas solution" 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. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
13	13	SECTION 1.01. Subtitle I, Title 4, Government Code, is
14	14	amended by adding Chapter 540 to read as follows:
15	15	CHAPTER 540. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
16	16	SUBCHAPTER A. GENERAL PROVISIONS
17	17	Sec. 540.001. DEFINITIONS. In this chapter:
18	18	(1) "Health benefit exchange" means an American Health
19	19	Benefit Exchange administered by the federal government or an
20	20	exchange created under Section 1311(b) of the Patient Protection
21	21	and Affordable Care Act (42 U.S.C. Section 18031(b)).
22	22	(2) "Medicaid program" means the medical assistance
23	23	program established and operated under Title XIX, Social Security
24	24	Act (42 U.S.C. Section 1396 et seq.).
25	25	(3) "State Medicaid program" means the medical
26	26	assistance program provided by this state under the Medicaid
27	27	program.
28	28	Sec. 540.002. FEDERAL AUTHORIZATION TO REFORM MEDICAID
29	29	REQUIRED. If the federal government establishes, through
30	30	conversion or otherwise, a block grant funding system for the
31	31	Medicaid program or otherwise authorizes the state Medicaid program
32	32	to operate under a block grant funding system, including under a
33	33	Medicaid program waiver, the commission, in cooperation with
34	34	applicable health and human services agencies, shall, subject to
35	35	Section 540.003, administer and operate the state Medicaid program
36	36	in accordance with this chapter.
37	37	Sec. 540.003. CONFLICT WITH OTHER LAW. To the extent of a
38	38	conflict between a provision of this chapter and:
39	39	(1) another provision of state law, the provision of
40	40	this chapter controls, subject to Section 540.002(b); and
41	41	(2) a provision of federal law or any authorization
42	42	described under Section 540.002, the federal law or authorization
43	43	controls.
44	44	Sec. 540.004. ESTABLISHMENT OF REFORMED STATE MEDICAID
45	45	PROGRAM. The commission shall establish a state Medicaid program
46	46	that provides benefits under a risk-based Medicaid managed care
47	47	model.
48	48	Sec. 540.005. RULES. The executive commissioner shall
49	49	adopt rules necessary to implement this chapter.
50	50	SUBCHAPTER B. ACUTE CARE
51	51	Sec. 540.051. ELIGIBILITY FOR MEDICAID ACUTE CARE. (a) An
52	52	individual is eligible to receive acute care benefits under the
53	53	state Medicaid program if the individual:
54	54	(1) has a household income at or below 100 percent of
55	55	the federal poverty level;
56	56	(2) is under 19 years of age and:
57	57	(A) is receiving Supplemental Security Income
58	58	(SSI) under 42 U.S.C. Section 1381 et seq.; or
59	59	(B) is in foster care or resides in another
60	60	residential care setting under the conservatorship of the
61	61	Department of Family and Protective Services; or
62	62	(3) meets the eligibility requirements that were in
63	63	effect on September 1, 2015.
64	64	(b) The commission shall provide acute care benefits under
65	65	the state Medicaid program to each individual eligible under this
66	66	section through the most cost-effective means, as determined by the
67	67	commission.
68	68	(c) If an individual is not eligible for the state Medicaid
69	69	program under Subsection (a), the commission shall refer the
70	70	individual to the program established under Chapter 541 that helps
71	71	connect eligible residents with health benefit plan coverage
72	72	through private market solutions, a health benefit exchange, or any
73	73	other resource the commission determines appropriate.
74	74	Sec. 540.052. MEDICAID SLIDING SCALE SUBSIDIES. (a) An
75	75	individual who is eligible for the state Medicaid program under
76	76	Section 540.051 may receive a Medicaid sliding scale subsidy to
77	77	purchase a health benefit plan from an authorized health benefit
78	78	plan issuer.
79	79	(b) A sliding scale subsidy provided to an individual under
80	80	this section must:
81	81	(1) be based on:
82	82	(A) the average premium in the market; and
83	83	(B) a realistic assessment of the individual's
84	84	ability to pay a portion of the premium; and
85	85	(2) include an enhancement for individuals who choose
86	86	a high deductible health plan with a health savings account.
87	87	(c) The commission shall ensure that counselors are made
88	88	available to individuals receiving a subsidy to advise the
89	89	individuals on selecting a health benefit plan that meets the
90	90	individuals' needs.
91	91	(d) An individual receiving a subsidy under this section is
92	92	responsible for paying:
93	93	(1) any difference between the premium costs
94	94	associated with the purchase of a health benefit plan and the amount
95	95	of the individual's subsidy under this section; and
96	96	(2) any copayments associated with the health benefit
97	97	plan.
98	98	(e) If the amount of a subsidy received by an individual
99	99	under this section exceeds the premium costs associated with the
100	100	individual's purchase of a health benefit plan, the individual may
101	101	deposit the excess amount in a health savings account that may be
102	102	used only in the manner described by Section 540.054(b).
103	103	Sec. 540.053. ADDITIONAL COST-SHARING SUBSIDIES. In
104	104	addition to providing a subsidy to an individual under Section
105	105	540.052, the commission shall provide additional subsidies for
106	106	coinsurance payments, copayments, deductibles, and other
107	107	cost-sharing requirements associated with the individual's health
108	108	benefit plan. The commission shall provide the additional
109	109	subsidies on a sliding scale based on income.
110	110	Sec. 540.054. DELIVERY OF SUBSIDIES; HEALTH SAVINGS
111	111	ACCOUNTS. (a) The commission shall determine the most appropriate
112	112	manner for delivering and administering subsidies provided under
113	113	Sections 540.052 and 540.053. In determining the most appropriate
114	114	manner, the commission shall consider depositing subsidy amounts
115	115	for an individual in a health savings account established for that
116	116	individual.
117	117	(b) A health savings account established under this section
118	118	may be used only to:
119	119	(1) pay health benefit plan premiums and cost-sharing
120	120	amounts; and
121	121	(2) if appropriate, purchase health care-related
122	122	goods and services.
123	123	Sec. 540.055. MEDICAID HEALTH BENEFIT PLAN ISSUERS AND
124	124	MINIMUM COVERAGE. The commission shall allow any health benefit
125	125	plan issuer authorized to write health benefit plans in this state
126	126	to participate in the state Medicaid program. The commission in
127	127	consultation with the commissioner of insurance shall establish
128	128	minimum coverage requirements for a health benefit plan to be
129	129	eligible for purchase under the state Medicaid program, subject to
130	130	the requirements specified by this chapter.
131	131	Sec. 540.056. REINSURANCE FOR PARTICIPATING HEALTH BENEFIT
132	132	PLAN ISSUERS. (a) The commission in consultation with the
133	133	commissioner of insurance shall study a reinsurance program to
134	134	reinsure participating health benefit plan issuers.
135	135	(b) In examining options for a reinsurance program, the
136	136	commission and commissioner of insurance shall consider a plan
137	137	design under which:
138	138	(1) a participating health benefit plan is not charged
139	139	a premium for the reinsurance; and
140	140	(2) the health benefit plan issuer retains risk on a
141	141	sliding scale.
142	142	SUBCHAPTER C. LONG-TERM SERVICES AND SUPPORTS
143	143	Sec. 540.101. PLAN TO REFORM DELIVERY OF LONG-TERM SERVICES
144	144	AND SUPPORTS. The commission shall develop a comprehensive plan to
145	145	reform the delivery of long-term services and supports that is
146	146	designed to achieve the following objectives under the state
147	147	Medicaid program or any other program created as an alternative to
148	148	the state Medicaid program:
149	149	(1) encourage consumer direction;
150	150	(2) simplify and streamline the provision of services;
151	151	(3) provide flexibility to design benefits packages
152	152	that meet the needs of individuals receiving long-term services and
153	153	supports under the program;
154	154	(4) improve the cost-effectiveness and sustainability
155	155	of the provision of long-term services and supports;
156	156	(5) reduce reliance on institutional settings; and
157	157	(6) encourage cost sharing by family members when
158	158	appropriate.
159	159	ARTICLE 2. IMMEDIATE REFORM: PROGRAM TO ENSURE HEALTH BENEFIT
160	160	COVERAGE FOR CERTAIN INDIVIDUALS THROUGH PRIVATE MARKETPLACE
161	161	SECTION 2.01. Subtitle I, Title 4, Government Code, is
162	162	amended by adding Chapter 541 to read as follows:
163	163	CHAPTER 541. PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR
164	164	CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS
165	165	SUBCHAPTER A. GENERAL PROVISIONS
166	166	Sec. 541.001. DEFINITION. In this chapter, "medical
167	167	assistance program" means the program established under Chapter 32,
168	168	Human Resources Code.
169	169	Sec. 541.002. CONFLICT WITH OTHER LAW. (a) Except as
170	170	provided by Subsection (b), to the extent of a conflict between a
171	171	provision of this chapter and:
172	172	(1) another provision of state law, the provision of
173	173	this chapter controls; and
174	174	(2) a provision of federal law or any authorization
175	175	described under Subchapter B, the federal law or authorization
176	176	controls.
177	177	(b) The program operated under this chapter is in addition
178	178	to any medical assistance program operated under a block grant
179	179	funding system under Chapter 540.
180	180	Sec. 541.003. PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE
181	181	THROUGH PRIVATE MARKET SOLUTIONS. Subject to the requirements of
182	182	this chapter, the commission in consultation with the Texas
183	183	Department of Insurance shall develop and implement a program that
184	184	helps connect certain low-income residents of this state with
185	185	health benefit plan coverage through private market solutions.
186	186	Sec. 541.004. NOT AN ENTITLEMENT. This chapter does not
187	187	establish an entitlement to assistance in obtaining health benefit
188	188	plan coverage.
189	189	Sec. 541.005. RULES. The executive commissioner shall
190	190	adopt rules necessary to implement this chapter.
191	191	SUBCHAPTER B. FEDERAL AUTHORIZATION
192	192	Sec. 541.051. FEDERAL AUTHORIZATION FOR FLEXIBILITY TO
193	193	ESTABLISH PROGRAM. (a) The commission in consultation with the
194	194	Texas Department of Insurance shall negotiate with the United
195	195	States secretary of health and human services, the federal Centers
196	196	for Medicare and Medicaid Services, and other appropriate persons
197	197	for purposes of seeking a waiver or other authorization necessary
198	198	to obtain the flexibility to use federal matching funds to help
199	199	provide, in accordance with Subchapter C, health benefit plan
200	200	coverage to certain low-income individuals through private market
201	201	solutions.
202	202	(b) Any agreement reached under this section must:
203	203	(1) create a program that is made cost neutral to this
204	204	state by:
205	205	(A) leveraging premium tax revenues; and
206	206	(B) achieving cost savings through offsets to
207	207	general revenue health care costs or the implementation of other
208	208	cost savings mechanisms;
209	209	(2) create more efficient health benefit plan coverage
210	210	options for eligible individuals through:
211	211	(A) program changes that may be made without the
212	212	need for additional federal approval; and
213	213	(B) program changes that require additional
214	214	federal approval;
215	215	(3) require the commission to achieve efficiency and
216	216	reduce unnecessary utilization, including duplication, of health
217	217	care services;
218	218	(4) be designed with the goals of:
219	219	(A) relieving local tax burdens;
220	220	(B) reducing general revenue reliance so as to
221	221	make general revenue available for other state priorities; and
222	222	(C) minimizing the impact of any federal health
223	223	care laws on Texas-based businesses; and
224	224	(5) afford this state the opportunity to develop a
225	225	state-specific solution with benefits that specifically meet the
226	226	unique needs of this state's population.
227	227	(c) An agreement reached under this section may be:
228	228	(1) limited in duration; and
229	229	(2) contingent on continued funding by the federal
230	230	government.
231	231	SUBCHAPTER C. PROGRAM REQUIREMENTS
232	232	Sec. 541.101. ENROLLMENT ELIGIBILITY. (a) Subject to
233	233	Subsection (b), an individual may be eligible to enroll in a program
234	234	designed and established under this chapter if the person:
235	235	(1) is younger than 65;
236	236	(2) has a household income at or below 133 percent of
237	237	the federal poverty level; and
238	238	(3) is not otherwise eligible to receive benefits
239	239	under the medical assistance program, including through a program
240	240	operated under Chapter 540 through a block grant funding system or a
241	241	waiver, other than one granted under this chapter, to the program.
242	242	(b) The executive commissioner may amend or further define
243	243	the eligibility requirements of this section if the commission
244	244	determines it necessary to reach an agreement under Subchapter B.
245	245	Sec. 541.102. MINIMUM PROGRAM REQUIREMENTS. A program
246	246	designed and established under this chapter must:
247	247	(1) if cost-effective for this state, provide premium
248	248	assistance to purchase health benefit plan coverage in the private
249	249	market, including health benefit plan coverage offered through a
250	250	managed care delivery model;
251	251	(2) provide enrollees with access to health benefits,
252	252	including benefits provided through a managed care delivery model,
253	253	that:
254	254	(A) are tailored to the enrollees;
255	255	(B) provide levels of coverage that are
256	256	customized to meet health care needs of individuals within defined
257	257	categories of the enrolled population; and
258	258	(C) emphasize personal responsibility and
259	259	accountability through flexible and meaningful cost sharing
260	260	requirements and wellness initiatives, including through
261	261	incentives for compliance with health, wellness, and treatment
262	262	strategies and disincentives for noncompliance;
263	263	(3) include pay-for-performance initiatives for
264	264	private health benefit plan issuers that participate in the
265	265	program;
266	266	(4) use technology to maximize the efficiency with
267	267	which the commission and any health benefit plan issuer, health
268	268	care provider, or managed care organization participating in the
269	269	program manages enrollee participation;
270	270	(5) allow recipients under the medical assistance
271	271	program to enroll in the program to receive premium assistance as an
272	272	alternative to the medical assistance program;
273	273	(6) encourage eligible individuals to enroll in other
274	274	private or employer-sponsored health benefit plan coverage, if
275	275	available and appropriate;
276	276	(7) encourage the utilization of health care services
277	277	in the most appropriate low-cost settings; and
278	278	(8) establish health savings accounts for enrollees,
279	279	as appropriate.
280	280	SECTION 2.02. The Health and Human Services Commission in
281	281	consultation with the Texas Department of Insurance and the
282	282	Medicaid Reform Task Force shall actively develop a proposal for
283	283	the authorization from the appropriate federal entity as required
284	284	by Subchapter B, Chapter 541, Government Code, as added by this
285	285	article. As soon as possible after the effective date of this Act,
286	286	the Health and Human Services Commission shall request and actively
287	287	pursue obtaining the authorization from the appropriate federal
288	288	entity.
289	289	ARTICLE 3. MEDICAID: INCREMENTAL REFORM
290	290	SECTION 3.01. Subchapter B, Chapter 531, Government Code,
291	291	is amended by adding Section 531.0974 to read as follows:
292	292	Sec. 531.0974. CUSTOMIZED BENEFITS PACKAGE. The commission
293	293	shall, for individuals receiving home and community-based services
294	294	and supports instead of institutional long-term services and
295	295	supports, develop and implement customized benefits packages that
296	296	are designed to prevent the overutilization of services. Customized
297	297	benefits packages under this section must be based on an
298	298	individualized needs assessment administered at a single point of
299	299	entry.
300	300	SECTION 3.02. Subchapter B, Chapter 32, Human Resources
301	301	Code, is amended by adding Sections 32.0501, 32.0642, and 32.077 to
302	302	read as follows:
303	303	Sec. 32.0501. DUAL ELIGIBLE INTEGRATED CARE DEMONSTRATION
304	304	PROJECT. (a) In this section:
305	305	(1) "ICF-IDD" has the meaning assigned to "ICF-MR" by
306	306	Section 531.002, Health and Safety Code.
307	307	(2) "Nursing facility" has the meaning assigned by
308	308	Section 531.912, Government Code.
309	309	(3) "State supported living center" has the meaning
310	310	assigned by Section 531.002, Health and Safety Code.
311	311	(b) Subject to Subsection (c), the department shall
312	312	establish a dual eligible integrated care demonstration project
313	313	that would allow appropriate individuals described by Section
314	314	32.050(a), as determined by the department, to receive long-term
315	315	services and supports under both the medical assistance program and
316	316	the Medicare program through a single managed care plan.
317	317	(c) An individual who is a resident of a nursing facility,
318	318	ICF-IDD, or state supported living center is exempt from
319	319	participation in the demonstration project.
320	320	Sec. 32.0642. PARENTAL FEE PROGRAM. (a) To the extent
321	321	allowed by federal law, the department shall establish a parental
322	322	fee program that requires the parent or legal guardian of a child
323	323	receiving institutional long-term services and supports or home and
324	324	community-based services and supports under the medical assistance
325	325	program established under this chapter to pay a fee that:
326	326	(1) correlates with the services and supports
327	327	provided; and
328	328	(2) takes into consideration the child's household
329	329	income.
330	330	(b) Failure to pay a fee under this section may not affect a
331	331	child's eligibility for benefits under the medical assistance
332	332	program.
333	333	(c) The executive commissioner of the Health and Human
334	334	Services Commission shall adopt rules necessary to implement this
335	335	section.
336	336	Sec. 32.077. HOUSING BENEFITS FOR CERTAIN RECIPIENTS. To
337	337	the extent allowed by federal law, the department shall provide
338	338	housing payment assistance for recipients receiving home and
339	339	community-based services and supports under the medical assistance
340	340	program established under this chapter.
341	341	SECTION 3.03. (a) The Health and Human Services Commission
342	342	shall conduct a study to examine the estate recovery program
343	343	implemented by this state under 42 U.S.C. Section 1396p(b)(1) and
344	344	determine options the state has to improve recovery under and
345	345	increase the efficacy of the program.
346	346	(b) Not later than December 1, 2016, the commission shall
347	347	submit a written report containing the findings of the study
348	348	conducted under this section together with the commission's
349	349	recommendations to the governor, the lieutenant governor, and the
350	350	standing committees of the senate and house of representatives
351	351	having primary jurisdiction over the Medicaid program.
352	352	SECTION 3.04. (a) The Health and Human Services Commission
353	353	shall conduct a study on imposing alternative income and asset
354	354	limits for purposes of determining eligibility for long-term
355	355	services and supports under the medical assistance program under
356	356	Chapter 32, Human Resources Code. The commission shall consider:
357	357	(1) imposing greater restrictions on exempt assets;
358	358	(2) limiting the amount of income that an individual
359	359	may transfer into a qualified trust under 42 U.S.C. Section
360	360	1396p(d)(4)(B) to an amount equal to the average cost of nursing
361	361	home care; and
362	362	(3) reducing the income eligibility limit to qualify
363	363	for Medicaid institutional long-term services and supports or home
364	364	and community-based waiver services under the medical assistance
365	365	program under Chapter 32, Human Resources Code.
366	366	(b) Not later than December 1, 2016, the commission shall
367	367	submit a written report containing the findings of the study
368	368	conducted under this section together with the commission's
369	369	recommendations to the governor, the lieutenant governor, and the
370	370	standing committees of the senate and house of representatives
371	371	having primary jurisdiction over the Medicaid program.
372	372	ARTICLE 4. MEDICAID REFORM TASK FORCE
373	373	SECTION 4.01. (a) In this section:
374	374	(1) "Commission" means the Health and Human Services
375	375	Commission.
376	376	(2) "Medicaid program" and "state Medicaid program"
377	377	have the meanings assigned by Section 540.001, Government Code, as
378	378	added by this Act.
379	379	(3) "Task force" means the Medicaid Reform Task Force
380	380	established under this section.
381	381	(b) The Medicaid Reform Task Force is established for
382	382	purposes of advising the commission in designing a state Medicaid
383	383	plan and program and a program for ensuring health benefit plan
384	384	coverage for low-income individuals that are:
385	385	(1) consistent with Articles 2 and 3 of this Act; and
386	386	(2) if the federal government establishes a block
387	387	grant funding system in accordance with Section 540.002, Government
388	388	Code, as added by this Act, consistent with Article 1 of this Act.
389	389	(c) The task force consists of 12 members appointed as
390	390	follows:
391	391	(1) one member appointed by the governor;
392	392	(2) two members of the senate appointed by the
393	393	lieutenant governor;
394	394	(3) two members of the house of representatives
395	395	appointed by the speaker of the house of representatives;
396	396	(4) one member from the Senate Committee on Finance,
397	397	appointed by the presiding officer;
398	398	(5) one member from the House Appropriations
399	399	Committee, appointed by the presiding officer;
400	400	(6) one member of the Senate Committee on Health and
401	401	Human Services, appointed by the presiding officer;
402	402	(7) one member of the House Public Health Committee,
403	403	appointed by the presiding officer;
404	404	(8) the executive commissioner of the commission or
405	405	the executive commissioner's designee;
406	406	(9) the commissioner of insurance or the
407	407	commissioner's designee to represent the Texas Department of
408	408	Insurance; and
409	409	(10) the director of the Legislative Budget Board or
410	410	the director's designee.
411	411	(d) The lieutenant governor and the speaker of the house of
412	412	representatives shall each appoint a member of the task force to act
413	413	as co-presiding officers.
414	414	(e) A member of the task force serves without compensation.
415	415	(f) Not later than January 1, 2016, the appropriate
416	416	appointing officers shall appoint the members of the task force.
417	417	(g) Not later than December 1, 2016, the task force shall
418	418	submit a report to the legislature regarding its activities under
419	419	this section.
420	420	(h) This section expires September 1, 2017.
421	421	ARTICLE 5. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
422	422	SECTION 5.01. Subject to Section 2.02 of this Act, if before
423	423	implementing any provision of this Act a state agency determines
424	424	that a waiver or authorization from a federal agency is necessary
425	425	for implementation of that provision, the agency affected by the
426	426	provision shall request the waiver or authorization and may delay
427	427	implementing that provision until the waiver or authorization is
428	428	granted.
429	429	SECTION 5.02. This Act takes effect September 1, 2015.