Texas 2017 - 85th Regular

Texas House Bill HB3976 Compare Versions

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1		-	H.B. No. 3976
	1	+	By: Ashby, et al. (Senate Sponsor - Huffman) H.B. No. 3976
	2	+	(In the Senate - Received from the House May 5, 2017;
	3	+	May 5, 2017, read first time and referred to Committee on State
	4	+	Affairs; May 16, 2017, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 9, Nays 0;
	6	+	May 16, 2017, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR H.B. No. 3976 By: Huffman
2	9
3	10
	11	+	A BILL TO BE ENTITLED
4	12		AN ACT
5	13		relating to the administration of and benefits payable under the
6	14		Texas Public School Retired Employees Group Benefits Act.
7	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	16		SECTION 1. Section 1575.002, Insurance Code, is amended by
9	17		amending Subdivision (5) and adding Subdivisions (5-a) and (5-b) to
10	18		read as follows:
11	19		(5) "Health benefit plan" means any [a group insurance
12	20		policy, contract, or certificate, medical or hospital service
13	21		agreement, membership or subscription contract, salary
14	22		continuation plan, or similar] group arrangement to provide health
15	23		care benefits [services] or to pay or reimburse expenses for [of]
16	24		health care services.
17	25		(5-a) "Medicare Advantage plan" means a health benefit
18	26		plan operated under Part C of the Medicare program.
19	27		(5-b) "Medicare prescription drug plan" means a health
20	28		benefit plan operated under Part D of the Medicare program.
21	29		SECTION 2. Subchapter A, Chapter 1575, Insurance Code, is
22	30		amended by adding Section 1575.0025 to read as follows:
23	31		Sec. 1575.0025. REFERENCES TO BASIC PLAN. A reference in
24	32		this code to a "basic plan" under this chapter means a health
25	33		benefit plan provided under this chapter other than a Medicare
26	34		Advantage plan or a Medicare prescription drug plan.
27	35		SECTION 3. Section 1575.006(a), Insurance Code, is amended
28	36		to read as follows:
29	37		(a) The following are exempt from execution, attachment,
30	38		garnishment, or any other process:
31	39		(1) benefit payments, [including optional benefits
32	40		payments,] active employee and state contributions, and retiree,
33	41		surviving spouse, and surviving dependent child contributions;
34	42		(2) any rights, benefits, or payments accruing to any
35	43		person under this chapter; and
36	44		(3) any money in the fund.
37	45		SECTION 4. Section 1575.052(a), Insurance Code, is amended
38	46		to read as follows:
39	47		(a) The trustee may adopt rules, plans, procedures, and
40	48		orders reasonably necessary to implement this chapter, including:
41	49		(1) minimum benefit and financing standards for group
42	50		coverage for retirees, dependents, surviving spouses, and
43	51		surviving dependent children;
44	52		(2) [basic and optional] group coverage for retirees,
45	53		dependents, surviving spouses, and surviving dependent children;
46	54		(3) procedures for contributions and deductions;
47	55		(4) periods for enrollment and selection of [optional]
48	56		coverage and procedures for enrolling and exercising options under
49	57		the group program;
50	58		(5) procedures for claims administration;
51	59		(6) procedures to administer the fund; and
52	60		(7) a timetable for:
53	61		(A) developing minimum benefit and financial
54	62		standards for group coverage;
55	63		(B) establishing health benefit plans offered
56	64		under the group program [plans]; and
57	65		(C) taking bids and awarding contracts for health
58	66		benefit plans offered under the group program [plans].
59	67		SECTION 5. Section 1575.152, Insurance Code, is amended to
60	68		read as follows:
61	69		Sec. 1575.152. HEALTH BENEFIT [BASIC] PLAN MUST COVER
62	70		PREEXISTING CONDITIONS. A health benefit [basic] plan offered
63	71		under the group program, other than a Medicare Advantage plan or a
64	72		Medicare prescription drug plan, must cover preexisting
65	73		conditions.
66	74		SECTION 6. Section 1575.153, Insurance Code, is amended to
67	75		read as follows:
68	76		Sec. 1575.153. HEALTH BENEFIT PLAN [BASIC] COVERAGE FOR
69	77		RETIREES. (a) A retiree who applies for coverage during an
70	78		enrollment period may not be denied coverage in a health benefit
71	79		[basic] plan provided under this chapter for which the retiree is
72	80		eligible unless the trustee finds under Subchapter K that the
73	81		retiree defrauded or attempted to defraud the group program.
74	82		(b) A retiree who has coverage under a health benefit plan
75	83		offered under the group program shall pay a monthly contribution,
76	84		as determined by the trustee.
77	85		(c) As a condition of electing coverage under a health
78	86		benefit plan, the retiree must, in writing, authorize the trustee
79	87		to deduct the amount of the contribution from the retiree's monthly
80	88		annuity payment. The trustee shall deduct the contribution in the
81	89		manner and form determined by the trustee.
82	90		(d) Notwithstanding Subsection (b), a retiree is not
83	91		required to pay a monthly contribution under this section until the
84	92		2022 plan year if the retiree:
85	93		(1) has taken a disability retirement under the
86	94		Teacher Retirement System of Texas on or before January 1, 2017;
87	95		(2) is receiving disability retirement benefits from
88	96		the Teacher Retirement System of Texas; and
89	97		(3) is not eligible to enroll in Medicare.
90	98		(e) This subsection and Subsection (d) expire at the end of
91	99		the 2021 plan year on December 31, 2021.
92	100		SECTION 7. Section 1575.155(a), Insurance Code, is amended
93	101		to read as follows:
94	102		(a) A retiree participating in the group program is entitled
95	103		to secure for the retiree's dependents group coverage [provided for
96	104		the retiree] under this chapter for which the dependents are
97	105		eligible under this chapter or any other law, including
98	106		requirements established[, as determined] by the trustee.
99	107		SECTION 8. Section 1575.156, Insurance Code, is amended by
100	108		amending Subsection (a) and adding Subsections (c) and (d) to read
101	109		as follows:
102	110		(a) A surviving spouse who is entitled to group coverage
103	111		under this chapter may elect to retain or obtain coverage for which
104	112		the surviving spouse or dependents of the surviving spouse are
105	113		eligible [at the applicable rate for the deceased participant].
106	114		(c) A surviving spouse who elects under this section to
107	115		retain or obtain coverage under a health benefit plan offered under
108	116		the group program for the surviving spouse or dependents of the
109	117		surviving spouse shall pay a monthly contribution, as determined by
110	118		the trustee.
111	119		(d) As a condition of electing coverage under a health
112	120		benefit plan, the surviving spouse must, in writing, authorize the
113	121		trustee to deduct the amount of the contribution from the surviving
114	122		spouse's monthly annuity payment. The trustee shall deduct the
115	123		contribution in the manner and form determined by the trustee.
116	124		SECTION 9. Section 1575.157, Insurance Code, is amended to
117	125		read as follows:
118	126		Sec. 1575.157. COVERAGE FOR SURVIVING DEPENDENT CHILD. (a)
119	127		A surviving dependent child, the guardian of the child's estate, or
120	128		the person having custody of the child may elect to retain or obtain
121	129		group coverage for which the surviving dependent child is eligible
122	130		at the applicable rate for a dependent.
123	131		(b) A surviving dependent child who has coverage under a
124	132		health benefit plan offered under the group program shall pay a
125	133		monthly contribution, as determined by the trustee. The applicable
126	134		contributions must be provided by the surviving dependent child in
127	135		the manner established [by Section 1575.205 and] by the trustee.
128	136		SECTION 10. The heading to Section 1575.158, Insurance
129	137		Code, is amended to read as follows:
130	138		Sec. 1575.158. [OPTIONAL] GROUP HEALTH BENEFIT PLANS
131	139		[PLAN].
132	140		SECTION 11. Section 1575.158, Insurance Code, is amended by
133	141		amending Subsection (a) and adding Subsections (c), (d), and (e) to
134	142		read as follows:
135	143		(a) The [Subject to Section 1575.1581, the] trustee shall
136	144		establish or [may, in addition to providing a basic plan,] contract
137	145		for and make available under the group program a high deductible [an
138	146		optional group] health [benefit] plan for retirees, dependents,
139	147		surviving spouses, or surviving dependent children who are eligible
140	148		under Section 1575.1582.
141	149		(c) The trustee shall establish or contract for and make
142	150		available under the group program a Medicare Advantage plan and a
143	151		Medicare prescription drug plan for retirees, dependents,
144	152		surviving spouses, and surviving dependent children who are
145	153		eligible under Section 1575.1582.
146	154		(d) Notwithstanding Subsection (c), if the trustee
147	155		determines that a Medicare Advantage plan or a Medicare
148	156		prescription drug plan is no longer appropriate for the group
149	157		program, the trustee may establish or contract for and make
150	158		available under the group program other health benefit plans to
151	159		provide medical or pharmacy benefits.
152	160		(e) To the extent the group program has available funds, the
153	161		trustee shall consider implementing a plan design for non-Medicare
154	162		eligible enrollees in the high deductible health plan established
155	163		or made available under Subsection (a) that provides assistance in
156	164		the payment of preventive care, including generic preventive
157	165		maintenance medications, in a manner that is consistent with
158	166		federal law.
159	167		SECTION 12. Subchapter D, Chapter 1575, Insurance Code, is
160	168		amended by adding Section 1575.1582 to read as follows:
161	169		Sec. 1575.1582. ELIGIBILITY FOR GROUP HEALTH BENEFIT PLANS.
162	170		(a) A retiree, dependent, surviving spouse, or surviving dependent
163	171		child who is not eligible to enroll in Medicare is eligible to
164	172		enroll in a high deductible health plan offered under the group
165	173		program, subject to any other applicable eligibility requirements,
166	174		including requirements established by the trustee, but is not
167	175		eligible to enroll in another health benefit plan offered under the
168	176		group program.
169	177		(b) A retiree, dependent, surviving spouse, or surviving
170	178		dependent child who is eligible to enroll in Medicare is eligible to
171	179		enroll in a Medicare Advantage plan or a Medicare prescription drug
172	180		plan offered under the group program, subject to any other
173	181		applicable eligibility requirements, including requirements
174	182		established by the trustee, but is not eligible to enroll in another
175	183		health benefit plan offered under the group program unless
176	184		authorized by Subsection (c).
177	185		(c) If the trustee makes another health benefit plan
178	186		available under Section 1575.158(d), any individual otherwise
179	187		eligible under this section to enroll in a Medicare Advantage plan
180	188		or Medicare prescription drug plan is eligible to enroll in that
181	189		health benefit plan.
182	190		SECTION 13. Section 1575.159, Insurance Code, is amended to
183	191		read as follows:
184	192		Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN
185	193		TEST. A health benefit plan offered under the group program, other
186	194		than a Medicare Advantage plan or a Medicare prescription drug
187	195		plan, must provide coverage for a medically accepted
188	196		prostate-specific antigen test used for the detection of prostate
189	197		cancer for each male enrolled in the health benefit plan who:
190	198		(1) is at least 50 years of age; or
191	199		(2) is at least 40 years of age and:
192	200		(A) has a family history of prostate cancer; or
193	201		(B) exhibits another cancer risk factor.
194	202		SECTION 14. The heading to Section 1575.161, Insurance
195	203		Code, is amended to read as follows:
196	204		Sec. 1575.161. [OPEN ENROLLMENT; ADDITIONAL] ENROLLMENT
197	205		PERIODS.
198	206		SECTION 15. Section 1575.161, Insurance Code, is amended by
199	207		amending Subsection (a) and adding Subsection (f) to read as
200	208		follows:
201	209		(a) A retiree eligible for coverage under the group program
202	210		may select for the retiree and the retiree's eligible dependents
203	211		any coverage provided under this chapter for which each of those
204	212		individuals [the person] is otherwise eligible:
205	213		(1) on any date that is on or after the date the
206	214		retiree [person] retires and on or before the 90th day after that
207	215		date;
208	216		(2) during a period beginning on the date the retiree
209	217		reaches 65 years of age and ending on a date set by the trustee by
210	218		rule; and
211	219		(3) [(2)] during any other open enrollment periods for
212	220		retirees set by the trustee by rule.
213	221		(f) An individual enrolled in a health benefit plan offered
214	222		under the group program may remain enrolled in that health benefit
215	223		plan as long as the individual remains eligible for that health
216	224		benefit plan. If an individual becomes ineligible for a health
217	225		benefit plan in which the individual is enrolled, the trustee shall
218	226		enroll the individual in a health benefit plan for which the
219	227		individual is eligible, if any, in accordance with procedures
220	228		established by the trustee.
221	229		SECTION 16. Section 1575.164(b), Insurance Code, is amended
222	230		to read as follows:
223	231		(b) A health benefit plan provided under this chapter, other
224	232		than a Medicare Advantage plan or a Medicare prescription drug
225	233		plan, must provide disease management services or coverage for
226	234		disease management services in the manner required by the Teacher
227	235		Retirement System of Texas, including:
228	236		(1) patient self-management education;
229	237		(2) provider education;
230	238		(3) evidence-based models and minimum standards of
231	239		care;
232	240		(4) standardized protocols and participation
233	241		criteria; and
234	242		(5) physician-directed or physician-supervised care.
235	243		SECTION 17. Section 1575.170(b), Insurance Code, is amended
236	244		to read as follows:
237	245		(b) A health benefit plan provided under this chapter, other
238	246		than a Medicare Advantage plan or a Medicare prescription drug
239	247		plan, that uses a drug formulary in providing a prescription drug
240	248		benefit must require prior authorization for coverage of the
241	249		following categories of prescribed drugs if the specific drug
242	250		prescribed is not included in the formulary:
243	251		(1) a gastrointestinal drug;
244	252		(2) a cholesterol-lowering drug;
245	253		(3) an anti-inflammatory drug;
246	254		(4) an antihistamine; and
247	255		(5) an antidepressant drug.
248	256		SECTION 18. Section 1575.201, Insurance Code, is amended by
249	257		amending Subsection (a) and adding Subsection (c) to read as
250	258		follows:
251	259		(a) The state through the trustee shall contribute from
252	260		money in the fund an[:
253	261		[(1) the total cost of the basic plan covering each
254	262		participating retiree; and
255	263		[(2) for each participating dependent, surviving
256	264		spouse, and surviving dependent child, the] amount prescribed by
257	265		the General Appropriations Act to cover all or part of the cost for
258	266		each retiree [of the basic plan covering the dependent], surviving
259	267		spouse, and surviving dependent child enrolled in a health benefit
260	268		plan offered under the group program.
261	269		(c) The trustee may spend a part of the money received for
262	270		the group program to offset a part of the costs for dependent
263	271		coverage if the group program is projected to remain financially
264	272		solvent during the currently funded biennium.
265	273		SECTION 19. Section 1575.202(a), Insurance Code, is amended
266	274		to read as follows:
267	275		(a) Each state fiscal year, the state shall contribute to
268	276		the fund an amount equal to 1.25 [one] percent of the salary of each
269	277		active employee.
270	278		SECTION 20. Section 1575.210(a), Insurance Code, is amended
271	279		to read as follows:
272	280		(a) Contributions allocated and appropriated under this
273	281		subchapter for a state fiscal year shall be:
274	282		(1) paid [from the general revenue fund] in equal
275	283		monthly installments;
276	284		(2) based on the estimated amount certified by the
277	285		trustee to the comptroller for that year; and
278	286		(3) subject to any express limitations specified in
279	287		the Act making the appropriation.
280	288		SECTION 21. Section 1575.211(a), Insurance Code, is amended
281	289		to read as follows:
282	290		(a) The total costs for the operation of the group program
283	291		shall be shared among the state, the public schools, the active
284	292		employees, [and] the retirees, the surviving spouses, and the
285	293		surviving dependent children in the manner prescribed by the
286	294		General Appropriations Act.
287	295		SECTION 22. Section 1575.212, Insurance Code, is amended by
288	296		adding Subsection (a-1) and amending Subsection (b) to read as
289	297		follows:
290	298		(a-1) The trustee shall establish and collect payments for
291	299		the share of total costs allocated under Section 1575.211 to
292	300		retirees, surviving spouses, and surviving dependent children.
293	301		(b) In establishing the payments under Subsection (a-1)
294	302		[ranges for payment of the share of total costs allocated under
295	303		Section 1575.211 to retirees], the trustee may consider various
296	304		factors, including an enrollee's Medicare status, health benefit
297	305		plan election, and dependent coverage [the years of service credit
298	306		accrued by a retiree and may reward those retirees with more years
299	307		of service credit].
300	308		SECTION 23. Section 1575.302, Insurance Code, is amended to
301	309		read as follows:
302	310		Sec. 1575.302. PAYMENTS INTO FUND. The following shall be
303	311		paid into the fund:
304	312		(1) contributions from active employees and the
305	313		state[, including contributions for optional coverages];
306	314		(2) investment income;
307	315		(3) appropriations for implementation of the group
308	316		program; and
309	317		(4) other money required or authorized to be paid into
310	318		the fund.
311	319		SECTION 24. The following provisions of the Insurance Code
312	320		are repealed:
313	321		(1) Section 1575.103;
314	322		(2) Section 1575.156(b);
315	323		(3) Section 1575.158(b);
316	324		(4) Section 1575.1581;
317	325		(5) Sections 1575.161(b), (c), (d), and (e);
318	326		(6) Section 1575.201(b);
319	327		(7) Section 1575.205;
320	328		(8) Section 1575.211(b); and
321	329		(9) Section 1575.212(a).
322	330		SECTION 25. The changes in law made by this Act apply only
323	331		to health benefits provided under Chapter 1575, Insurance Code, as
324	332		amended by this Act, beginning with the 2018 plan year. A plan year
325	333		before the 2018 plan year is governed by the law as it existed
326	334		immediately before the effective date of this Act, and that law is
327	335		continued in effect for that purpose.
328	336		SECTION 26. This Act takes effect September 1, 2017.
329		-	______________________________ ______________________________
330		-	President of the Senate Speaker of the House
331		-	I certify that H.B. No. 3976 was passed by the House on May 4,
332		-	2017, by the following vote: Yeas 140, Nays 0, 2 present, not
333		-	voting; and that the House concurred in Senate amendments to H.B.
334		-	No. 3976 on May 24, 2017, by the following vote: Yeas 139, Nays 0,
335		-	2 present, not voting.
336		-	______________________________
337		-	Chief Clerk of the House
338		-	I certify that H.B. No. 3976 was passed by the Senate, with
339		-	amendments, on May 21, 2017, by the following vote: Yeas 31, Nays
340		-	0.
341		-	______________________________
342		-	Secretary of the Senate
343		-	APPROVED: __________________
344		-	Date
345		-	__________________
346		-	Governor
	337	+	* * * * *