Texas 2021 - 87th 3rd C.S.

Texas House Bill HB54 Compare Versions

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

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1	1	By: Reynolds H.B. No. 54
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	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	ARTICLE 1. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
12	12	SECTION 1.01. Subtitle I, Title 4, Government Code, is
13	13	amended by adding Chapter 540 to read as follows:
14	14	CHAPTER 540. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 540.0001. DEFINITIONS. Notwithstanding Section
17	17	531.001, 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. 540.0002. 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 540.0003, administer and operate the state Medicaid program
36	36	in accordance with this chapter.
37	37	Sec. 540.0003. 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 540A.0002(b); and
41	41	(2) a provision of federal law or any authorization
42	42	described under Section 540.0002, the federal law or authorization
43	43	controls.
44	44	Sec. 540.0004. 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. 540.0005. RULES. The executive commissioner shall
49	49	adopt rules necessary to implement this chapter.
50	50	SUBCHAPTER B. ACUTE CARE
51	51	Sec. 540.0051. 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 in this state on August 31, 2021.
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 540A 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. 540.0052. MEDICAID SLIDING SCALE SUBSIDIES. (a) An
75	75	individual who is eligible for the state Medicaid program under
76	76	Section 540.0051 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, except to the extent the individual receives an additional
98	98	subsidy under Section 540.0053 to pay the copayments.
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 Centers for Medicare
197	197	and Medicaid Services, and other appropriate persons for purposes
198	198	of seeking a waiver or other authorization necessary to obtain the
199	199	flexibility to use federal matching funds to help provide, in
200	200	accordance with Subchapter C, health benefit plan coverage to
201	201	certain low-income individuals through private market 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 way with benefits that specifically meet the unique
226	226	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. 540A.0101. 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 state Medicaid program, including through a program
240	240	operated under Chapter 32, Human Resources Code, or under Chapter
241	241	540 through a block grant funding system or a waiver, other than a
242	242	waiver granted under this chapter, to the program.
243	243	(b) The executive commissioner may modify or further define
244	244	the eligibility requirements of this section if the commission
245	245	determines it necessary to reach an agreement under Subchapter B.
246	246	Sec. 540A.0102. MINIMUM PROGRAM REQUIREMENTS. A program
247	247	designed and established under this chapter must:
248	248	(1) if cost-effective for this state, provide premium
249	249	assistance to purchase health benefit plan coverage in the private
250	250	market, including health benefit plan coverage offered through a
251	251	managed care delivery model;
252	252	(2) provide enrollees with access to health benefits,
253	253	including benefits provided through a managed care delivery model,
254	254	that:
255	255	(A) are tailored to the enrollees;
256	256	(B) provide levels of coverage that are
257	257	customized to meet health care needs of individuals within defined
258	258	categories of the enrolled population; and
259	259	(C) emphasize personal responsibility and
260	260	accountability through flexible and meaningful cost-sharing
261	261	requirements and wellness initiatives, including through
262	262	incentives for compliance with health, wellness, and treatment
263	263	strategies and disincentives for noncompliance;
264	264	(3) include pay-for-performance initiatives for
265	265	private health benefit plan issuers that participate in the
266	266	program;
267	267	(4) use technology to maximize the efficiency with
268	268	which the commission and any health benefit plan issuer, health
269	269	care provider, or managed care organization participating in the
270	270	program manage enrollee participation;
271	271	(5) allow recipients under the state Medicaid program
272	272	to enroll in the program to receive premium assistance as an
273	273	alternative to the state Medicaid program;
274	274	(6) encourage eligible individuals to enroll in other
275	275	private or employer-sponsored health benefit plan coverage, if
276	276	available and appropriate;
277	277	(7) encourage the utilization of health care services
278	278	in the most appropriate low-cost settings; and
279	279	(8) establish health savings accounts for enrollees,
280	280	as appropriate.
281	281	SECTION 2.02. The Health and Human Services Commission in
282	282	consultation with the commissioner of insurance shall actively
283	283	develop a proposal for the authorization from the appropriate
284	284	federal entity as required by Subchapter B, Chapter 540A,
285	285	Government Code, as added by this article. As soon as possible
286	286	after the effective date of this Act, the Health and Human Services
287	287	Commission shall request and actively pursue obtaining the
288	288	authorization from the appropriate federal entity.
289	289	ARTICLE 3. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
290	290	SECTION 3.01. Subject to Section 2.02 of this Act, if before
291	291	implementing any provision of this Act a state agency determines
292	292	that a waiver or authorization from a federal agency is necessary
293	293	for implementation of that provision, the agency affected by the
294	294	provision shall request the waiver or authorization and may delay
295	295	implementing that provision until the waiver or authorization is
296	296	granted.
297	297	SECTION 3.02. This Act takes effect on the 91st day after
298	298	the last day of the legislative session.