Texas 2019 - 86th Regular

Texas House Bill HB1395 Compare Versions

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

Old	New	Differences
1	1	86R6674 KFF-F
2	2	By: Reynolds H.B. No. 1395
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a "Texas Way" to reforming and addressing issues
8	8	related to the Medicaid program, including the creation of an
9	9	alternative program designed to ensure health benefit plan coverage
10	10	to certain low-income individuals through the private marketplace.
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. 540.0001. DEFINITIONS. Notwithstanding Section
18	18	531.001, in this chapter:
19	19	(1) "Health benefit exchange" means an American Health
20	20	Benefit Exchange administered by the federal government or an
21	21	exchange created under Section 1311(b) of the Patient Protection
22	22	and Affordable Care Act (42 U.S.C. Section 18031(b)).
23	23	(2) "Medicaid program" means the medical assistance
24	24	program established and operated under Title XIX, Social Security
25	25	Act (42 U.S.C. Section 1396 et seq.).
26	26	(3) "State Medicaid program" means the medical
27	27	assistance program provided by this state under the Medicaid
28	28	program.
29	29	Sec. 540.0002. FEDERAL AUTHORIZATION TO REFORM MEDICAID
30	30	REQUIRED. If the federal government establishes, through
31	31	conversion or otherwise, a block grant funding system for the
32	32	Medicaid program or otherwise authorizes the state Medicaid program
33	33	to operate under a block grant funding system, including under a
34	34	Medicaid program waiver, the commission, in cooperation with
35	35	applicable health and human services agencies, shall, subject to
36	36	Section 540.0003, administer and operate the state Medicaid program
37	37	in accordance with this chapter.
38	38	Sec. 540.0003. CONFLICT WITH OTHER LAW. To the extent of a
39	39	conflict between a provision of this chapter and:
40	40	(1) another provision of state law, the provision of
41	41	this chapter controls, subject to Section 540A.0002(b); and
42	42	(2) a provision of federal law or any authorization
43	43	described under Section 540.0002, the federal law or authorization
44	44	controls.
45	45	Sec. 540.0004. ESTABLISHMENT OF REFORMED STATE MEDICAID
46	46	PROGRAM. The commission shall establish a state Medicaid program
47	47	that provides benefits under a risk-based Medicaid managed care
48	48	model.
49	49	Sec. 540.0005. RULES. The executive commissioner shall
50	50	adopt rules necessary to implement this chapter.
51	51	SUBCHAPTER B. ACUTE CARE
52	52	Sec. 540.0051. ELIGIBILITY FOR MEDICAID ACUTE CARE. (a) An
53	53	individual is eligible to receive acute care benefits under the
54	54	state Medicaid program if the individual:
55	55	(1) has a household income at or below 100 percent of
56	56	the federal poverty level;
57	57	(2) is under 19 years of age and:
58	58	(A) is receiving Supplemental Security Income
59	59	(SSI) under 42 U.S.C. Section 1381 et seq.; or
60	60	(B) is in foster care or resides in another
61	61	residential care setting under the conservatorship of the
62	62	Department of Family and Protective Services; or
63	63	(3) meets the eligibility requirements that were in
64	64	effect on September 1, 2013.
65	65	(b) The commission shall provide acute care benefits under
66	66	the state Medicaid program to each individual eligible under this
67	67	section through the most cost-effective means, as determined by the
68	68	commission.
69	69	(c) If an individual is not eligible for the state Medicaid
70	70	program under Subsection (a), the commission shall refer the
71	71	individual to the program established under Chapter 540A that helps
72	72	connect eligible residents with health benefit plan coverage
73	73	through private market solutions, a health benefit exchange, or any
74	74	other resource the commission determines appropriate.
75	75	Sec. 540.0052. MEDICAID SLIDING SCALE SUBSIDIES. (a) An
76	76	individual who is eligible for the state Medicaid program under
77	77	Section 540.0051 may receive a Medicaid sliding scale subsidy to
78	78	purchase a health benefit plan from an authorized health benefit
79	79	plan issuer.
80	80	(b) A sliding scale subsidy provided to an individual under
81	81	this section must:
82	82	(1) be based on:
83	83	(A) the average premium in the market; and
84	84	(B) a realistic assessment of the individual's
85	85	ability to pay a portion of the premium; and
86	86	(2) include an enhancement for individuals who choose
87	87	a high deductible health plan with a health savings account.
88	88	(c) The commission shall ensure that counselors are made
89	89	available to individuals receiving a subsidy to advise the
90	90	individuals on selecting a health benefit plan that meets the
91	91	individuals' needs.
92	92	(d) An individual receiving a subsidy under this section is
93	93	responsible for paying:
94	94	(1) any difference between the premium costs
95	95	associated with the purchase of a health benefit plan and the amount
96	96	of the individual's subsidy under this section; and
97	97	(2) any copayments associated with the health benefit
98	98	plan.
99	99	(e) If the amount of a subsidy received by an individual
100	100	under this section exceeds the premium costs associated with the
101	101	individual's purchase of a health benefit plan, the individual may
102	102	deposit the excess amount in a health savings account that may be
103	103	used only in the manner described by Section 540.0054(b).
104	104	Sec. 540.0053. ADDITIONAL COST-SHARING SUBSIDIES. In
105	105	addition to providing a subsidy to an individual under Section
106	106	540.0052, the commission shall provide additional subsidies for
107	107	coinsurance payments, copayments, deductibles, and other
108	108	cost-sharing requirements associated with the individual's health
109	109	benefit plan. The commission shall provide the additional
110	110	subsidies on a sliding scale based on income.
111	111	Sec. 540.0054. DELIVERY OF SUBSIDIES; HEALTH SAVINGS
112	112	ACCOUNTS. (a) The commission shall determine the most appropriate
113	113	manner for delivering and administering subsidies provided under
114	114	Sections 540.0052 and 540.0053. In determining the most
115	115	appropriate manner, the commission shall consider depositing
116	116	subsidy amounts for an individual in a health savings account
117	117	established for that individual.
118	118	(b) A health savings account established under this section
119	119	may be used only to:
120	120	(1) pay health benefit plan premiums and cost-sharing
121	121	amounts; and
122	122	(2) if appropriate, purchase health care-related
123	123	goods and services.
124	124	Sec. 540.0055. MEDICAID HEALTH BENEFIT PLAN ISSUERS AND
125	125	MINIMUM COVERAGE. The commission shall allow any health benefit
126	126	plan issuer authorized to write health benefit plans in this state
127	127	to participate in the state Medicaid program. The commission in
128	128	consultation with the commissioner of insurance shall establish
129	129	minimum coverage requirements for a health benefit plan to be
130	130	eligible for purchase under the state Medicaid program, subject to
131	131	the requirements specified by this chapter.
132	132	Sec. 540.0056. REINSURANCE FOR PARTICIPATING HEALTH
133	133	BENEFIT PLAN ISSUERS. (a) The commission in consultation with the
134	134	commissioner of insurance shall study a reinsurance program to
135	135	reinsure participating health benefit plan issuers.
136	136	(b) In examining options for a reinsurance program, the
137	137	commission and the commissioner of insurance shall consider a plan
138	138	design under which:
139	139	(1) a participating health benefit plan is not charged
140	140	a premium for the reinsurance; and
141	141	(2) the health benefit plan issuer retains risk on a
142	142	sliding scale.
143	143	SUBCHAPTER C. LONG-TERM SERVICES AND SUPPORTS
144	144	Sec. 540.0101. PLAN TO REFORM DELIVERY OF LONG-TERM
145	145	SERVICES AND SUPPORTS. The commission shall develop a
146	146	comprehensive plan to reform the delivery of long-term services and
147	147	supports that is designed to achieve the following objectives under
148	148	the state Medicaid program or any other program created as an
149	149	alternative to the state Medicaid program:
150	150	(1) encourage consumer direction;
151	151	(2) simplify and streamline the provision of services;
152	152	(3) provide flexibility to design benefits packages
153	153	that meet the needs of individuals receiving long-term services and
154	154	supports under the program;
155	155	(4) improve the cost-effectiveness and sustainability
156	156	of the provision of long-term services and supports;
157	157	(5) reduce reliance on institutional settings; and
158	158	(6) encourage cost-sharing by family members when
159	159	appropriate.
160	160	ARTICLE 2. PROGRAM TO ENSURE HEALTH BENEFIT COVERAGE FOR CERTAIN
161	161	INDIVIDUALS THROUGH PRIVATE MARKETPLACE
162	162	SECTION 2.01. Subtitle I, Title 4, Government Code, is
163	163	amended by adding Chapter 540A to read as follows:
164	164	CHAPTER 540A. PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR
165	165	CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS
166	166	SUBCHAPTER A. GENERAL PROVISIONS
167	167	Sec. 540A.0001. DEFINITION. In this chapter, "state
168	168	Medicaid program" has the meaning assigned by Section 540.0001.
169	169	Sec. 540A.0002. 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 the state Medicaid program operated under Chapter 32, Human
179	179	Resources Code, or under a block grant funding system under Chapter
180	180	540.
181	181	Sec. 540A.0003. PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE
182	182	THROUGH PRIVATE MARKET SOLUTIONS. Subject to the requirements of
183	183	this chapter, the commission in consultation with the commissioner
184	184	of insurance shall develop and implement a program that helps
185	185	connect certain low-income residents of this state with health
186	186	benefit plan coverage through private market solutions.
187	187	Sec. 540A.0004. NOT AN ENTITLEMENT. This chapter does not
188	188	establish an entitlement to assistance in obtaining health benefit
189	189	plan coverage.
190	190	Sec. 540A.0005. RULES. The executive commissioner shall
191	191	adopt rules necessary to implement this chapter.
192	192	SUBCHAPTER B. FEDERAL AUTHORIZATION
193	193	Sec. 540A.0051. FEDERAL AUTHORIZATION FOR FLEXIBILITY TO
194	194	ESTABLISH PROGRAM. (a) The commission in consultation with the
195	195	commissioner of insurance shall negotiate with the United States
196	196	secretary of health and human services, the federal Centers for
197	197	Medicare and Medicaid Services, and other appropriate persons for
198	198	purposes of seeking a waiver or other authorization necessary to
199	199	obtain the flexibility to use federal matching funds to help
200	200	provide, in accordance with Subchapter C, health benefit plan
201	201	coverage to certain low-income individuals through private market
202	202	solutions.
203	203	(b) Any agreement reached under this section must:
204	204	(1) create a program that is made cost neutral to this
205	205	state by:
206	206	(A) leveraging premium tax revenues; and
207	207	(B) achieving cost savings through offsets to
208	208	general revenue health care costs or the implementation of other
209	209	cost savings mechanisms;
210	210	(2) create more efficient health benefit plan coverage
211	211	options for eligible individuals through:
212	212	(A) program changes that may be made without the
213	213	need for additional federal approval; and
214	214	(B) program changes that require additional
215	215	federal approval;
216	216	(3) require the commission to achieve efficiency and
217	217	reduce unnecessary utilization, including duplication, of health
218	218	care services;
219	219	(4) be designed with the goals of:
220	220	(A) relieving local tax burdens;
221	221	(B) reducing general revenue reliance so as to
222	222	make general revenue available for other state priorities; and
223	223	(C) minimizing the impact of any federal health
224	224	care laws on Texas-based businesses; and
225	225	(5) afford this state the opportunity to develop a
226	226	state-specific way with benefits that specifically meet the unique
227	227	needs of this state's population.
228	228	(c) An agreement reached under this section may be:
229	229	(1) limited in duration; and
230	230	(2) contingent on continued funding by the federal
231	231	government.
232	232	SUBCHAPTER C. PROGRAM REQUIREMENTS
233	233	Sec. 540A.0101. ENROLLMENT ELIGIBILITY. (a) Subject to
234	234	Subsection (b), an individual may be eligible to enroll in a program
235	235	designed and established under this chapter if the person:
236	236	(1) is younger than 65;
237	237	(2) has a household income at or below 133 percent of
238	238	the federal poverty level; and
239	239	(3) is not otherwise eligible to receive benefits
240	240	under the state Medicaid program, including through a program
241	241	operated under Chapter 32, Human Resources Code, or under Chapter
242	242	540 through a block grant funding system or a waiver, other than a
243	243	waiver granted under this chapter, to the program.
244	244	(b) The executive commissioner may modify or further define
245	245	the eligibility requirements of this section if the commission
246	246	determines it necessary to reach an agreement under Subchapter B.
247	247	Sec. 540A.0102. MINIMUM PROGRAM REQUIREMENTS. A program
248	248	designed and established under this chapter must:
249	249	(1) if cost-effective for this state, provide premium
250	250	assistance to purchase health benefit plan coverage in the private
251	251	market, including health benefit plan coverage offered through a
252	252	managed care delivery model;
253	253	(2) provide enrollees with access to health benefits,
254	254	including benefits provided through a managed care delivery model,
255	255	that:
256	256	(A) are tailored to the enrollees;
257	257	(B) provide levels of coverage that are
258	258	customized to meet health care needs of individuals within defined
259	259	categories of the enrolled population; and
260	260	(C) emphasize personal responsibility and
261	261	accountability through flexible and meaningful cost-sharing
262	262	requirements and wellness initiatives, including through
263	263	incentives for compliance with health, wellness, and treatment
264	264	strategies and disincentives for noncompliance;
265	265	(3) include pay-for-performance initiatives for
266	266	private health benefit plan issuers that participate in the
267	267	program;
268	268	(4) use technology to maximize the efficiency with
269	269	which the commission and any health benefit plan issuer, health
270	270	care provider, or managed care organization participating in the
271	271	program manages enrollee participation;
272	272	(5) allow recipients under the state Medicaid program
273	273	to enroll in the program to receive premium assistance as an
274	274	alternative to the state Medicaid program;
275	275	(6) encourage eligible individuals to enroll in other
276	276	private or employer-sponsored health benefit plan coverage, if
277	277	available and appropriate;
278	278	(7) encourage the utilization of health care services
279	279	in the most appropriate low-cost settings; and
280	280	(8) establish health savings accounts for enrollees,
281	281	as appropriate.
282	282	SECTION 2.02. The Health and Human Services Commission in
283	283	consultation with the commissioner of insurance shall actively
284	284	develop a proposal for the authorization from the appropriate
285	285	federal entity as required by Subchapter B, Chapter 540A,
286	286	Government Code, as added by this article. As soon as possible
287	287	after the effective date of this Act, the Health and Human Services
288	288	Commission shall request and actively pursue obtaining the
289	289	authorization from the appropriate federal entity.
290	290	ARTICLE 3. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
291	291	SECTION 3.01. Subject to Section 2.02 of this Act, if before
292	292	implementing any provision of this Act a state agency determines
293	293	that a waiver or authorization from a federal agency is necessary
294	294	for implementation of that provision, the agency affected by the
295	295	provision shall request the waiver or authorization and may delay
296	296	implementing that provision until the waiver or authorization is
297	297	granted.
298	298	SECTION 3.02. This Act takes effect September 1, 2019.