85R14756 SCL-F
By: Gooden H.B. No. 4068
A BILL TO BE ENTITLED
AN ACT
relating to regional or local health care programs for eligible
individuals and employees of small employers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 75, Health and Safety
Code, is amended to read as follows:
CHAPTER 75. REGIONAL OR LOCAL HEALTH CARE PROGRAMS FOR ELIGIBLE
INDIVIDUALS AND EMPLOYEES OF SMALL EMPLOYERS
SECTION 2. Section 75.001, Health and Safety Code, is
amended to read as follows:
Sec. 75.001. PURPOSE. The purpose of this chapter is to:
(1) improve the health of eligible individuals and
employees of small employers and their families by improving the
individuals' and employees' access to health care and by reducing
the number of those individuals and employees who are uninsured;
(2) reduce the likelihood that those individuals and
employees and their families will require services from
state-funded entitlement programs such as Medicaid;
(3) contribute to economic development by helping
small businesses remain competitive with a healthy workforce and
optional health care benefits that will attract employees; and
(4) encourage innovative solutions for providing and
funding health care services and benefits.
SECTION 3. Section 75.002, Health and Safety Code, is
amended by amending Subdivisions (1), (3), and (4) and adding
Subdivision (1-a) to read as follows:
(1) "Eligible individual" means an individual
eligible for participation in a regional or local health care
program established under this chapter.
(1-a) "Employee" means an individual employed by an
employer. The term includes a partner of a partnership and the
proprietor of a sole proprietorship.
(3) "Local health care program" means a local health
care program operating in one county and established for the
benefit of eligible individuals and the employees of small
employers under Subchapter B.
(4) "Regional health care program" means a regional
health care program operating in two or more counties and
established for the benefit of eligible individuals and the
employees of small employers under Subchapter B.
SECTION 4. Sections 75.052 and 75.053, Health and Safety
Code, are amended to read as follows:
Sec. 75.052. GOVERNANCE OF PROGRAM. (a) [A regional health
care program may be operated subject to the direct governance of the
commissioners courts of the participating counties. A local health
care program may be operated subject to the direct governance of the
commissioners court of the participating county.] A regional or
local health care program must [may] be operated by a [joint
council,] tax-exempt nonprofit entity[, or other entity that:
[(1) operates the program under a contract with the
commissioners court or courts, as applicable; or
[(2) is an entity in which the county or counties
participate or that is established or designated by the
commissioners court or courts, as applicable, to operate the
program].
(b) An [In selecting an] entity operating [described by
Subsection (a)(1) or (2) to operate] a regional or local health care
program must [, the commissioners court or courts, as applicable,
shall require, to the extent possible, that the entity] be
authorized under federal law to accept donations on a basis that is
tax-deductible or otherwise tax-advantaged for the contributor.
Sec. 75.053. OPERATION OF PROGRAM. A regional or local
health care program provides health care services or benefits to
eligible individuals and the employees of participating small
employers who are located within the boundaries of the
participating county or counties, as applicable. A program may
also provide services or benefits to the dependents of those
individuals and employees.
SECTION 5. Subchapter B, Chapter 75, Health and Safety
Code, is amended by adding Section 75.0545 to read as follows:
Sec. 75.0545. PARTICIPATION BY ELIGIBLE INDIVIDUALS; SHARE
OF COST. Subject to Section 75.153, the governing body may
establish criteria for participation in a regional or local health
care program by eligible individuals and their dependents. The
criteria must require that participating individuals pay a share of
the premium or other cost of the program.
SECTION 6. Section 75.055(c), Health and Safety Code, is
amended to read as follows:
(c) A governing body shall actively solicit gifts, grants,
and donations to:
(1) fund services and benefits provided under the
regional or local health care program; and
(2) reduce the cost of participation in the program
for eligible individuals and for small employers and their
employees.
SECTION 7. Section 75.101, Health and Safety Code, is
amended to read as follows:
Sec. 75.101. ALTERNATIVE PROGRAMS AUTHORIZED; PROGRAM
OBJECTIVES. In developing a regional or local health care program,
a governing body may provide health care services or benefits as
described by this subchapter or may develop another type of program
to accomplish the purposes of this chapter. A regional or local
health care program must be developed, to the extent practicable,
to:
(1) reduce the number of individuals without health
benefit plan coverage [within the boundaries of the participating
county or counties];
(2) address rising health care costs and reduce the
cost of health care services or health benefit plan coverage [for
small employers and their employees within the boundaries of the
participating county or counties];
(3) promote preventive care and reduce the incidence
of preventable health conditions, such as heart disease, cancer,
and diabetes and low birth weight in infants;
(4) promote efficient and collaborative delivery of
health care services;
(5) serve as a model for the innovative use of health
information technology to promote efficient delivery of health care
services, reduce health care costs, and improve the health of the
community; and
(6) provide fair payment rates for health care
providers, to the extent applicable.
SECTION 8. Sections 75.102(a), (c), and (d), Health and
Safety Code, are amended to read as follows:
(a) A regional or local health care program may provide
health care benefits to eligible individuals and the employees of
small employers by purchasing or facilitating the purchase of
health benefit plan coverage for those individuals and employees
from a health benefit plan issuer, including coverage under:
(1) a small employer health benefit plan offered under
Chapter 1501, Insurance Code;
(2) a standard health benefit plan offered under
Chapter 1507, Insurance Code; or
(3) any other health benefit plan available in this
state.
(c) Notwithstanding Chapter 1251, Insurance Code, an
insurer may issue a group accident and health insurance policy,
including a group contract issued by a group hospital service
corporation, to cover eligible individuals and the employees of
small employers participating in a regional or local health care
program. The group policyholder of a policy issued in accordance
with this subsection is the governing body or the designee of the
governing body.
(d) A health maintenance organization may issue a health
care plan to cover eligible individuals and the employees of small
employers participating in a regional or local health care program.
The group contract holder of a contract issued in accordance with
this subsection is the governing body or the designee of the
governing body.
SECTION 9. Sections 75.104(a) and (c), Health and Safety
Code, are amended to read as follows:
(a) A regional or local health care program may contract
with health care providers within the boundaries of the
participating county or counties to provide health care services
directly to eligible individuals, the employees of participating
small employers, and the dependents of those individuals and
employees.
(c) A governing body that operates a regional or local
health care program under this section may require that
participating eligible individuals, employees, and dependents
obtain health care services only from health care providers that
contract to provide those services under the program and may limit
the health care services provided under the program to services
provided within the boundaries of the program's service area
[participating county or counties].
SECTION 10. This Act takes effect September 1, 2017.