Texas 2023 - 88th Regular

Texas House Bill HB652 Compare Versions

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1	1	88R3705 JG-D
2	2	By: Johnson of Dallas H.B. No. 652
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the development and implementation of the Live Well
8	8	Texas program and the expansion of Medicaid eligibility to provide
9	9	health benefit coverage to certain individuals; imposing
10	10	penalties.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subtitle I, Title 4, Government Code, is amended
13	13	by adding Chapters 537A and 537B to read as follows:
14	14	CHAPTER 537A. LIVE WELL TEXAS PROGRAM
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 537A.0001. DEFINITIONS. In this chapter:
17	17	(1) "Basic plan" means the program health benefit plan
18	18	described by Section 537A.0202.
19	19	(2) "Eligible individual" means an individual who is
20	20	eligible to participate in the program.
21	21	(3) "Participant" means an individual who is:
22	22	(A) enrolled in a program health benefit plan; or
23	23	(B) receiving health care financial assistance
24	24	under Subchapter H.
25	25	(4) "Plus plan" means the program health benefit plan
26	26	described by Section 537A.0203.
27	27	(5) "POWER account" means a personal wellness and
28	28	responsibility account the commission establishes for a
29	29	participant under Section 537A.0251.
30	30	(6) "Program" means the Live Well Texas program
31	31	established under this chapter.
32	32	(7) "Program health benefit plan" includes:
33	33	(A) the basic plan; and
34	34	(B) the plus plan.
35	35	(8) "Program health benefit plan provider" means a
36	36	health benefit plan provider that contracts with the commission
37	37	under Section 537A.0107 to arrange for the provision of health care
38	38	services through a program health benefit plan.
39	39	SUBCHAPTER B. FEDERAL WAIVER FOR LIVE WELL TEXAS PROGRAM
40	40	Sec. 537A.0051. FEDERAL AUTHORIZATION FOR PROGRAM. (a)
41	41	Notwithstanding any other law, the executive commissioner shall
42	42	develop and seek a waiver under Section 1115 of the Social Security
43	43	Act (42 U.S.C. Section 1315) to the state Medicaid plan to implement
44	44	the Live Well Texas program to assist individuals in obtaining
45	45	health benefit coverage through a program health benefit plan or
46	46	health care financial assistance.
47	47	(b) The terms of a waiver the executive commissioner seeks
48	48	under this section must:
49	49	(1) be designed to:
50	50	(A) provide health benefit coverage options for
51	51	eligible individuals;
52	52	(B) produce better health outcomes for
53	53	participants;
54	54	(C) create incentives for participants to
55	55	transition from receiving public assistance benefits to achieving
56	56	stable employment;
57	57	(D) promote personal responsibility and engage
58	58	participants in making decisions regarding health care based on
59	59	cost and quality;
60	60	(E) support participants' self-sufficiency by
61	61	requiring unemployed participants to be referred to work search and
62	62	job training programs;
63	63	(F) support participants who become ineligible
64	64	to participate in a program health benefit plan in transitioning to
65	65	private health benefit coverage; and
66	66	(G) leverage enhanced federal medical assistance
67	67	percentage funding to minimize or eliminate the need for a program
68	68	enrollment cap; and
69	69	(2) allow for the operation of the program consistent
70	70	with the requirements of this chapter, except to the extent
71	71	deviation from the requirements is necessary to obtain federal
72	72	authorization of the waiver.
73	73	Sec. 537A.0052. FUNDING. Subject to approval of the waiver
74	74	described by Section 537A.0051, the commission shall implement the
75	75	program using enhanced federal medical assistance percentage
76	76	funding available under the Patient Protection and Affordable Care
77	77	Act (Pub. L. No. 111-148) as amended by the Health Care and
78	78	Education Reconciliation Act of 2010 (Pub. L. No. 111-152).
79	79	Sec. 537A.0053. NOT AN ENTITLEMENT; TERMINATION OF PROGRAM.
80	80	(a) This chapter does not establish an entitlement to health
81	81	benefit coverage or health care financial assistance under the
82	82	program for eligible individuals.
83	83	(b) The program terminates at the time the share of federal
84	84	funding for the program under the Patient Protection and Affordable
85	85	Care Act (Pub. L. No. 111-148) as amended by the Health Care and
86	86	Education Reconciliation Act of 2010 (Pub. L. No. 111-152) is
87	87	reduced below 90 percent.
88	88	SUBCHAPTER C. PROGRAM ADMINISTRATION
89	89	Sec. 537A.0101. PROGRAM OBJECTIVE. The program's principal
90	90	objective is to provide primary and preventative health care
91	91	through high deductible program health benefit plans to eligible
92	92	individuals.
93	93	Sec. 537A.0102. PROGRAM PROMOTION. The commission shall
94	94	promote and provide information about the program to individuals
95	95	who:
96	96	(1) are potentially eligible to participate in the
97	97	program; and
98	98	(2) live in medically underserved areas of this state.
99	99	Sec. 537A.0103. COMMISSION'S AUTHORITY RELATED TO HEALTH
100	100	BENEFIT PLAN PROVIDER CONTRACTS. The commission may:
101	101	(1) enter into contracts with health benefit plan
102	102	providers under Section 537A.0107;
103	103	(2) monitor program health benefit plan providers
104	104	through reporting requirements and other means to ensure contract
105	105	performance and quality delivery of services;
106	106	(3) monitor the quality of services delivered to
107	107	participants through outcome measurements; and
108	108	(4) provide payment under the contracts to program
109	109	health benefit plan providers.
110	110	Sec. 537A.0104. COMMISSION'S AUTHORITY RELATED TO
111	111	ELIGIBILITY AND MEDICAID COORDINATION. The commission may:
112	112	(1) accept applications for health benefit coverage
113	113	under the program and implement program eligibility screening and
114	114	enrollment procedures;
115	115	(2) resolve grievances related to eligibility
116	116	determinations; and
117	117	(3) to the extent possible, coordinate the program
118	118	with Medicaid.
119	119	Sec. 537A.0105. THIRD-PARTY ADMINISTRATOR CONTRACT FOR
120	120	PROGRAM IMPLEMENTATION. (a) In administering the program, the
121	121	commission may contract with a third-party administrator to provide
122	122	enrollment and related services.
123	123	(b) If the commission contracts with a third-party
124	124	administrator under this section, the commission may:
125	125	(1) monitor the third-party administrator through
126	126	reporting requirements and other means to ensure contract
127	127	performance and quality delivery of services; and
128	128	(2) provide payment under the contract to the
129	129	third-party administrator.
130	130	(c) The executive commissioner shall retain all
131	131	policymaking authority over the program.
132	132	(d) The commission shall procure each contract with a
133	133	third-party administrator, as applicable, through a competitive
134	134	procurement process that complies with all federal and state laws.
135	135	Sec. 537A.0106. TEXAS DEPARTMENT OF INSURANCE DUTIES. (a)
136	136	At the commission's request, the Texas Department of Insurance
137	137	shall provide any necessary assistance with the program. The
138	138	department shall monitor the quality of the services provided by
139	139	program health benefit plan providers and resolve grievances
140	140	related to those providers.
141	141	(b) The commission and the Texas Department of Insurance may
142	142	adopt a memorandum of understanding that addresses the
143	143	responsibilities of each agency with respect to the program.
144	144	(c) The Texas Department of Insurance, in consultation with
145	145	the commission, shall adopt rules as necessary to implement this
146	146	section.
147	147	Sec. 537A.0107. HEALTH BENEFIT PLAN PROVIDER CONTRACTS.
148	148	The commission shall select through a competitive procurement
149	149	process that complies with all federal and state laws and contract
150	150	with health benefit plan providers to provide health care services
151	151	under the program. To be eligible for a contract under this section,
152	152	an entity must:
153	153	(1) be a Medicaid managed care organization;
154	154	(2) hold a certificate of authority issued by the
155	155	Texas Department of Insurance that authorizes the entity to provide
156	156	the types of health care services offered under the program; and
157	157	(3) satisfy, except as provided by this chapter, any
158	158	applicable requirement of the Insurance Code or another insurance
159	159	law of this state.
160	160	Sec. 537A.0108. HEALTH CARE PROVIDERS. (a) A health care
161	161	provider who provides health care services under the program must
162	162	meet certification and licensure requirements required by
163	163	commission rules and other law.
164	164	(b) In adopting rules governing the program, the executive
165	165	commissioner shall ensure that a health care provider who provides
166	166	health care services under the program is reimbursed at a rate that
167	167	is at least equal to the rate paid under Medicare for the provision
168	168	of the same or substantially similar services.
169	169	Sec. 537A.0109. PROHIBITION ON CERTAIN HEALTH CARE
170	170	PROVIDERS. The executive commissioner shall adopt rules that
171	171	prohibit a health care provider from providing program health care
172	172	services for a reasonable period, as determined by the executive
173	173	commissioner, if the health care provider:
174	174	(1) fails to repay program overpayments; or
175	175	(2) owns, controls, manages, or is otherwise
176	176	affiliated with and has financial, managerial, or administrative
177	177	influence over a health care provider who has been suspended or
178	178	prohibited from providing program health care services.
179	179	SUBCHAPTER D. ELIGIBILITY FOR PROGRAM HEALTH BENEFIT COVERAGE
180	180	Sec. 537A.0151. ELIGIBILITY REQUIREMENTS. (a) An
181	181	individual is eligible to enroll in a program health benefit plan
182	182	if:
183	183	(1) the individual is a resident of this state;
184	184	(2) the individual is 19 years of age or older but
185	185	younger than 65 years of age;
186	186	(3) applying the eligibility criteria in effect in
187	187	this state on December 31, 2022, the individual is not eligible for
188	188	Medicaid; and
189	189	(4) federal matching funds are available under the
190	190	Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
191	191	amended by the Health Care and Education Reconciliation Act of 2010
192	192	(Pub. L. No. 111-152) to provide benefits to the individual under
193	193	the federal medical assistance program established under Title XIX,
194	194	Social Security Act (42 U.S.C. Section 1396 et seq.).
195	195	(b) An individual who is a parent or caretaker relative to
196	196	whom 42 C.F.R. Section 435.110 applies is eligible to enroll in a
197	197	program health benefit plan.
198	198	(c) In determining eligibility for the program, the
199	199	commission shall apply the same eligibility criteria regarding
200	200	residency and citizenship in effect for Medicaid in this state on
201	201	December 31, 2022.
202	202	Sec. 537A.0152. CONTINUOUS COVERAGE. The commission shall
203	203	ensure that an individual who is initially determined or
204	204	redetermined to be eligible to participate in the program and
205	205	enroll in a program health benefit plan will remain eligible for
206	206	coverage under the plan for a period of 12 months beginning on the
207	207	first day of the month following the date eligibility was
208	208	determined or redetermined, subject to Section 537A.0252(f).
209	209	Sec. 537A.0153. APPLICATION FORM AND PROCEDURES. (a) The
210	210	executive commissioner shall adopt an application form and
211	211	application procedures for the program. The form and procedures
212	212	must be coordinated with forms and procedures under Medicaid to
213	213	ensure that there is a single consolidated application process to
214	214	seek health benefit coverage under the program or Medicaid.
215	215	(b) To the extent possible, the commission shall make the
216	216	application form available in languages other than English.
217	217	(c) The executive commissioner may permit an individual to
218	218	apply by mail, over the telephone, or through the Internet.
219	219	Sec. 537A.0154. ELIGIBILITY SCREENING AND ENROLLMENT. (a)
220	220	The executive commissioner shall adopt eligibility screening and
221	221	enrollment procedures or use the Texas Integrated Enrollment
222	222	Services eligibility determination system or a compatible system to
223	223	screen individuals and enroll eligible individuals in the program.
224	224	(b) The eligibility screening and enrollment procedures
225	225	must ensure that an individual applying for the program who appears
226	226	eligible for Medicaid is identified and assisted with obtaining
227	227	Medicaid coverage. If the individual is denied Medicaid coverage
228	228	but is determined eligible to enroll in a program health benefit
229	229	plan, the commission shall enroll the individual in a program
230	230	health benefit plan of the individual's choosing and for which the
231	231	individual is eligible without further application or
232	232	qualification.
233	233	(c) Not later than the 30th day after the date an individual
234	234	submits a complete application form and unless the individual is
235	235	identified and assisted with obtaining Medicaid coverage under
236	236	Subsection (b), the commission shall ensure that the individual's
237	237	eligibility to participate in the program is determined and that
238	238	the individual, if eligible, is provided with information on
239	239	program health benefit plans and program health benefit plan
240	240	providers. The commission shall enroll the individual in the
241	241	program health benefit plan and with the program health benefit
242	242	plan provider of the individual's choosing in a timely manner, as
243	243	determined by the commission.
244	244	(d) The executive commissioner may establish enrollment
245	245	periods for the program.
246	246	Sec. 537A.0155. ELIGIBILITY REDETERMINATION PROCESS;
247	247	DISENROLLMENT. (a) Not later than the 90th day before a
248	248	participant's coverage period expires, the commission shall notify
249	249	the participant regarding the eligibility redetermination process
250	250	and request documentation necessary to redetermine the
251	251	participant's eligibility.
252	252	(b) The commission shall provide written notice of
253	253	termination of eligibility to a participant not later than the 30th
254	254	day before the date the participant's eligibility will terminate.
255	255	The commission shall disenroll the participant from the program if:
256	256	(1) the participant does not submit the requested
257	257	eligibility redetermination documentation before the last day of
258	258	the participant's coverage period; or
259	259	(2) the commission, based on the submitted
260	260	documentation, determines the participant is no longer eligible for
261	261	the program, subject to Subchapter H.
262	262	(c) An individual may submit the requested eligibility
263	263	redetermination documentation not later than the 90th day after the
264	264	date the commission disenrolls the individual from the program. If
265	265	the commission determines that the individual continues to meet
266	266	program eligibility requirements, the commission shall reenroll
267	267	the individual in the program without any additional application
268	268	requirements.
269	269	(d) An individual who does not complete the eligibility
270	270	redetermination process in accordance with this section and who the
271	271	commission disenrolls from the program may not participate in the
272	272	program for a period of 180 days beginning on the date of
273	273	disenrollment. This subsection does not apply to an individual:
274	274	(1) described by Section 537A.0206 or 537A.0208; or
275	275	(2) who is:
276	276	(A) pregnant; or
277	277	(B) younger than 21 years of age.
278	278	(e) At the time the commission disenrolls a participant from
279	279	the program, the commission shall provide to the participant:
280	280	(1) notice that the participant may be eligible to
281	281	receive health care financial assistance under Subchapter H in
282	282	transitioning to private health benefit coverage; and
283	283	(2) information on and the eligibility requirements
284	284	for that financial assistance.
285	285	SUBCHAPTER E. BASIC AND PLUS PLANS
286	286	Sec. 537A.0201. BASIC AND PLUS PLAN COVERAGE GENERALLY.
287	287	(a) The basic and plus plans offered under the program must:
288	288	(1) comply with this subchapter and coverage
289	289	requirements prescribed by other law; and
290	290	(2) at a minimum, provide coverage for essential
291	291	health benefits required under 42 U.S.C. Section 18022(b).
292	292	(b) In modifying covered health benefits under the basic and
293	293	plus plans, the executive commissioner shall consider the health
294	294	care needs of healthy individuals and individuals with special
295	295	health care needs.
296	296	(c) The basic and plus plans must allow a participant with a
297	297	chronic, disabling, or life-threatening illness to select an
298	298	appropriate specialist as the participant's primary care
299	299	physician.
300	300	Sec. 537A.0202. BASIC PLAN: COVERAGE AND INCOME
301	301	ELIGIBILITY. (a) The program must include a basic plan that is
302	302	sufficient to meet the basic health care needs of individuals who
303	303	enroll in the plan.
304	304	(b) The covered health benefits under the basic plan must
305	305	include:
306	306	(1) primary care physician services;
307	307	(2) prenatal and postpartum care;
308	308	(3) specialty care physician visits;
309	309	(4) home health services, not to exceed 100 visits per
310	310	year;
311	311	(5) outpatient surgery;
312	312	(6) allergy testing;
313	313	(7) chemotherapy;
314	314	(8) intravenous infusion services;
315	315	(9) radiation therapy;
316	316	(10) dialysis;
317	317	(11) emergency care hospital services;
318	318	(12) emergency transportation, including ambulance
319	319	and air ambulance;
320	320	(13) urgent care clinic services;
321	321	(14) hospitalization, including for:
322	322	(A) general inpatient hospital care;
323	323	(B) inpatient physician services;
324	324	(C) inpatient surgical services;
325	325	(D) non-cosmetic reconstructive surgery;
326	326	(E) a transplant;
327	327	(F) treatment for a congenital abnormality;
328	328	(G) anesthesia;
329	329	(H) hospice care; and
330	330	(I) care in a skilled nursing facility for a
331	331	period not to exceed 100 days per occurrence;
332	332	(15) inpatient and outpatient behavioral health
333	333	services;
334	334	(16) inpatient, outpatient, and residential substance
335	335	use treatment;
336	336	(17) prescription drugs, including tobacco cessation
337	337	drugs;
338	338	(18) inpatient and outpatient rehabilitative and
339	339	habilitative care, including physical, occupational, and speech
340	340	therapy, not to exceed 60 combined visits per year;
341	341	(19) medical equipment, appliances, and assistive
342	342	technology, including prosthetics and hearing aids, and the repair,
343	343	technical support, and customization needed for individual use;
344	344	(20) laboratory and pathology tests and services;
345	345	(21) diagnostic imaging, including x-rays, magnetic
346	346	resonance imaging, computed tomography, and positron emission
347	347	tomography;
348	348	(22) preventative care services as described by
349	349	Section 537A.0204; and
350	350	(23) services under the early and periodic screening,
351	351	diagnostic, and treatment program for participants who are younger
352	352	than 21 years of age.
353	353	(c) To be eligible for health care benefits under the basic
354	354	plan, an individual who is eligible for the program must have an
355	355	annual household income that is equal to or less than 100 percent of
356	356	the federal poverty level.
357	357	Sec. 537A.0203. PLUS PLAN: COVERAGE AND INCOME ELIGIBILITY.
358	358	(a) The program must include a plus plan that includes the covered
359	359	health benefits listed in Section 537A.0202 and the following
360	360	additional enhanced health benefits:
361	361	(1) services related to the treatment of conditions
362	362	affecting the temporomandibular joint;
363	363	(2) dental care;
364	364	(3) vision care;
365	365	(4) notwithstanding Section 537A.0202(b)(18),
366	366	inpatient and outpatient rehabilitative and habilitative care,
367	367	including physical, occupational, and speech therapy, not to exceed
368	368	75 combined visits per year;
369	369	(5) bariatric surgery; and
370	370	(6) other services the commission considers
371	371	appropriate.
372	372	(b) An individual who is eligible for the program and whose
373	373	annual household income exceeds 100 percent of the federal poverty
374	374	level will automatically be enrolled in and receive health benefits
375	375	under the plus plan. An individual who is eligible for the program
376	376	and whose annual household income is equal to or less than 100
377	377	percent of the federal poverty level may choose to enroll in the
378	378	plus plan.
379	379	(c) A participant enrolled in the plus plan is required to
380	380	make POWER account contributions in accordance with Section
381	381	537A.0252.
382	382	Sec. 537A.0204. PREVENTATIVE CARE SERVICES. (a) The
383	383	commission shall provide to each participant a list of health care
384	384	services that qualify as preventative care services based on the
385	385	participant's age, gender, and preexisting conditions. In
386	386	developing the list, the commission shall consult with the federal
387	387	Centers for Disease Control and Prevention.
388	388	(b) A program health benefit plan shall, at no cost to the
389	389	participant, provide coverage for:
390	390	(1) preventative care services described by 42 U.S.C.
391	391	Section 300gg-13; and
392	392	(2) a maximum of $500 per year of preventative care
393	393	services other than those described by Subdivision (1).
394	394	(c) A participant who receives preventative care services
395	395	not described by Subsection (b) that are covered under the
396	396	participant's program health benefit plan is subject to deductible
397	397	and copayment requirements for the services in accordance with the
398	398	terms of the plan.
399	399	Sec. 537A.0205. COPAYMENTS. (a) A participant enrolled in
400	400	the basic plan shall pay a copayment for each covered health benefit
401	401	except for a preventative care or family planning service. The
402	402	executive commissioner by rule shall adopt a copayment schedule for
403	403	basic plan services, subject to Subsection (c).
404	404	(b) Except as provided by Subsection (c), a participant
405	405	enrolled in the plus plan may not be required to pay a copayment for
406	406	a covered service.
407	407	(c) A participant enrolled in the basic or plus plan shall
408	408	pay a copayment in an amount set by commission rule not to exceed
409	409	$25 for nonemergency use of hospital emergency department services
410	410	unless:
411	411	(1) the participant has met the cost-sharing maximum
412	412	for the calendar quarter, as prescribed by commission rule;
413	413	(2) the participant is referred to the hospital
414	414	emergency department by a health care provider;
415	415	(3) the visit is a true emergency, as defined by
416	416	commission rule; or
417	417	(4) the participant is pregnant.
418	418	Sec. 537A.0206. CERTAIN PARTICIPANTS ELIGIBLE FOR STATE
419	419	MEDICAID PLAN BENEFITS. (a) A participant described by 42 C.F.R.
420	420	Section 440.315 who is enrolled in the basic or plus plan is
421	421	entitled to receive under the program all health benefits that
422	422	would be available under the state Medicaid plan.
423	423	(b) A participant to which this section applies is subject
424	424	to the cost-sharing requirements, including copayment and POWER
425	425	account contribution requirements, of the program health benefit
426	426	plan in which the participant is enrolled.
427	427	(c) The commission shall develop screening measures to
428	428	identify participants to which this section applies.
429	429	Sec. 537A.0207. PREGNANT PARTICIPANTS. (a) A participant
430	430	who becomes pregnant while enrolled in the program and who meets the
431	431	eligibility requirements for Medicaid may choose to remain in the
432	432	program or enroll in Medicaid.
433	433	(b) A pregnant participant described by Subsection (a) who
434	434	is enrolled in the basic or plus plan and who remains in the program
435	435	is:
436	436	(1) notwithstanding Section 537A.0205, not subject to
437	437	any cost-sharing requirements, including copayment and POWER
438	438	account contribution requirements, of the program health benefit
439	439	plan in which the participant is enrolled until the expiration of
440	440	the second month following the month in which the pregnancy ends;
441	441	(2) entitled to receive as a Medicaid wrap-around
442	442	benefit all Medicaid services a pregnant woman enrolled in Medicaid
443	443	is entitled to receive, including a pharmacy benefit, when the
444	444	participant exceeds coverage limits under the participant's
445	445	program health benefit plan or if a service is not covered by the
446	446	plan; and
447	447	(3) eligible for additional vision and dental care
448	448	benefits.
449	449	Sec. 537A.0208. PARENTS AND CARETAKER RELATIVES. (a) A
450	450	parent or caretaker relative to whom 42 C.F.R. Section 435.110
451	451	applies is entitled to receive as a Medicaid wrap-around benefit
452	452	all Medicaid services to which the individual would be entitled
453	453	under the state Medicaid plan that are not covered under the
454	454	individual's program health benefit plan or exceed the plan's
455	455	coverage limits.
456	456	(b) An individual described by Subsection (a) who chooses to
457	457	participate in the program is subject to the cost-sharing
458	458	requirements, including copayment and POWER account contribution
459	459	requirements, of the program health benefit plan in which the
460	460	individual is enrolled.
461	461	SUBCHAPTER F. PERSONAL WELLNESS AND RESPONSIBILITY (POWER)
462	462	ACCOUNTS
463	463	Sec. 537A.0251. ESTABLISHMENT AND OPERATION OF POWER
464	464	ACCOUNTS. (a) The commission shall establish a personal wellness
465	465	and responsibility (POWER) account for each participant who is
466	466	enrolled in a program health benefit plan that is funded with money
467	467	contributed in accordance with this subchapter.
468	468	(b) The commission shall enable each participant to access
469	469	and manage money in and information regarding the participant's
470	470	POWER account through an electronic system. The commission may
471	471	contract with an entity that has appropriate experience and
472	472	expertise to establish, implement, or administer the electronic
473	473	system.
474	474	(c) Except as otherwise provided by Section 537A.0252, the
475	475	commission shall require each participant to contribute to the
476	476	participant's POWER account in amounts described by that section.
477	477	Sec. 537A.0252. POWER ACCOUNT CONTRIBUTIONS; DEDUCTIBLE.
478	478	(a) The executive commissioner by rule shall establish an annual
479	479	universal deductible for each participant enrolled in the basic or
480	480	plus plan.
481	481	(b) To ensure each participant's POWER account contains a
482	482	sufficient amount of money at the beginning of a coverage period,
483	483	the commission shall, before the beginning of that period, fund
484	484	each account with the following amounts:
485	485	(1) for a participant enrolled in the basic plan, the
486	486	annual universal deductible amount; and
487	487	(2) for a participant enrolled in the plus plan, the
488	488	difference between the annual universal deductible amount and the
489	489	participant's required annual contribution as determined by the
490	490	schedule established under Subsection (c).
491	491	(c) The executive commissioner by rule shall establish a
492	492	graduated annual POWER account contribution schedule for
493	493	participants enrolled in the plus plan that:
494	494	(1) is based on a participant's annual household
495	495	income, with participants whose annual household incomes are less
496	496	than the federal poverty level paying progressively less and
497	497	participants whose annual household incomes are equal to or greater
498	498	than the federal poverty level paying progressively more; and
499	499	(2) may not require a participant to contribute more
500	500	than a total of five percent of the participant's annual household
501	501	income to the participant's POWER account.
502	502	(d) A participant's employer may contribute on behalf of the
503	503	participant any amount of the participant's annual POWER account
504	504	contribution. A nonprofit organization may contribute on behalf of
505	505	a participant any amount of the participant's annual POWER account
506	506	contribution.
507	507	(e) Subject to the contribution cap described by Subsection
508	508	(c)(2) and not before the expiration of the participant's first
509	509	coverage period, the commission shall require a participant who
510	510	uses one or more tobacco products to contribute to the
511	511	participant's POWER account an annual POWER account contribution
512	512	amount that is one percent more than the participant would
513	513	otherwise be required to contribute under the schedule established
514	514	under Subsection (c).
515	515	(f) An annual POWER account contribution must be paid by or
516	516	on behalf of a participant monthly in installments that are at least
517	517	equal to one-twelfth of the total required contribution. The
518	518	coverage period for a participant whose annual household income
519	519	exceeds 100 percent of the federal poverty level may not begin until
520	520	the first day of the first month following the month in which the
521	521	first monthly installment is received.
522	522	Sec. 537A.0253. USE OF POWER ACCOUNT MONEY. A participant
523	523	may use money in the participant's POWER account to pay copayments
524	524	and deductible costs the participant's program health benefit plan
525	525	requires. The commission shall issue to each participant an
526	526	electronic payment card that allows the participant to use the card
527	527	to pay the program health benefit plan costs.
528	528	Sec. 537A.0254. PROGRAM HEALTH BENEFIT PLAN PROVIDER
529	529	REWARDS PROGRAM FOR ENGAGEMENT IN CERTAIN HEALTHY BEHAVIORS;
530	530	SMOKING CESSATION INITIATIVE. (a) A program health benefit plan
531	531	provider shall establish a rewards program through which a
532	532	participant receiving health care through a program health benefit
533	533	plan the program health benefit plan provider offers may earn money
534	534	to be contributed to the participant's POWER account.
535	535	(b) Under a rewards program, a program health benefit plan
536	536	provider shall contribute money to a participant's POWER account if
537	537	the participant engages in certain healthy behaviors. The
538	538	executive commissioner by rule shall determine:
539	539	(1) the behaviors in which a participant must engage
540	540	to receive a contribution, which must include behaviors related to:
541	541	(A) completion of a health risk assessment;
542	542	(B) smoking cessation; and
543	543	(C) as applicable, chronic disease management;
544	544	and
545	545	(2) the amount of money a program health benefit plan
546	546	provider shall contribute for each behavior described by
547	547	Subdivision (1).
548	548	(c) Subsection (b) does not prevent a program health benefit
549	549	plan provider from contributing money to a participant's POWER
550	550	account if the participant engages in a behavior not specified by
551	551	that subsection or a rule the executive commissioner adopts in
552	552	accordance with that subsection. If a program health benefit plan
553	553	provider chooses to contribute money under this subsection, the
554	554	program health benefit plan provider shall determine the amount of
555	555	money to be contributed for the behavior.
556	556	(d) A participant may use contributions a program health
557	557	benefit plan provider makes under a rewards program to offset a
558	558	maximum of 50 percent of the participant's required annual POWER
559	559	account contribution the executive commissioner establishes under
560	560	Section 537A.0252.
561	561	(e) Contributions a program health benefit plan provider
562	562	makes under a rewards program that result in a participant's POWER
563	563	account balance exceeding the participant's required annual POWER
564	564	account contribution may be rolled over into the next coverage
565	565	period in accordance with Section 537A.0256.
566	566	(f) During the first coverage period of a participant who
567	567	uses one or more tobacco products, a program health benefit plan
568	568	provider shall actively attempt to engage the participant in and
569	569	provide educational materials to the participant on:
570	570	(1) smoking cessation activities for which the
571	571	participant may receive a monetary contribution under this section;
572	572	and
573	573	(2) other smoking cessation programs or resources
574	574	available to the participant.
575	575	Sec. 537A.0255. MONTHLY STATEMENTS. The commission shall
576	576	distribute to each participant with a POWER account a monthly
577	577	statement that includes information on:
578	578	(1) the participant's POWER account activity during
579	579	the preceding month, including information on the cost of health
580	580	care services delivered to the participant during that month;
581	581	(2) the balance of money available in the POWER
582	582	account at the time the statement is issued; and
583	583	(3) the amount of any contributions due from the
584	584	participant.
585	585	Sec. 537A.0256. POWER ACCOUNT ROLL OVER. (a) The executive
586	586	commissioner by rule shall establish a process in accordance with
587	587	this section to roll over money in a participant's POWER account to
588	588	the succeeding coverage period. The commission shall calculate the
589	589	amount to be rolled over at the time the participant's program
590	590	eligibility is redetermined.
591	591	(b) For a participant enrolled in the basic plan, the
592	592	commission shall calculate the amount to be rolled over to a
593	593	subsequent coverage period POWER account from the participant's
594	594	current coverage period POWER account based on:
595	595	(1) the amount of money remaining in the participant's
596	596	POWER account from the current coverage period; and
597	597	(2) whether the participant received recommended
598	598	preventative care services during the current coverage period.
599	599	(c) For a participant enrolled in the plus plan who, as
600	600	determined by the commission, timely makes POWER account
601	601	contributions in accordance with this subchapter, the commission
602	602	shall calculate the amount to be rolled over to a subsequent
603	603	coverage period POWER account from the participant's current
604	604	coverage period POWER account based on:
605	605	(1) the amount of money remaining in the participant's
606	606	POWER account from the current coverage period;
607	607	(2) the total amount of money the participant
608	608	contributed to the participant's POWER account during the current
609	609	coverage period; and
610	610	(3) whether the participant received recommended
611	611	preventative care services during the current coverage period.
612	612	(d) Except as provided by Subsection (e), a participant may
613	613	use money rolled over into the participant's POWER account for the
614	614	succeeding coverage period to offset required annual POWER account
615	615	contributions, as applicable, during that coverage period.
616	616	(e) A participant enrolled in the basic plan who rolls over
617	617	money into the participant's POWER account for the succeeding
618	618	coverage period and who chooses to enroll in the plus plan for that
619	619	coverage period may use the money rolled over to offset a maximum of
620	620	50 percent of the required annual POWER account contributions for
621	621	that coverage period.
622	622	Sec. 537A.0257. REFUND. If at the end of a participant's
623	623	coverage period the participant chooses to cease participating in a
624	624	program health benefit plan or is no longer eligible to participate
625	625	in a program health benefit plan, or if the commission disenrolls a
626	626	participant from the program health benefit plan under Section
627	627	537A.0258 for failure to pay required contributions, the commission
628	628	shall refund to the participant any money the participant
629	629	contributed that remains in the participant's POWER account at the
630	630	end of the coverage period or on the disenrollment date.
631	631	Sec. 537A.0258. PENALTIES FOR FAILURE TO MAKE POWER ACCOUNT
632	632	CONTRIBUTIONS. (a) For a participant whose annual household
633	633	income exceeds 100 percent of the federal poverty level and who
634	634	fails to make a contribution in accordance with Section 537A.0252,
635	635	the commission shall provide a 60-day grace period during which the
636	636	participant may make the contribution without penalty. If the
637	637	participant fails to make the contribution during the grace period,
638	638	the commission shall disenroll the participant from the program
639	639	health benefit plan in which the participant is enrolled and the
640	640	participant may not reenroll in a program health benefit plan
641	641	until:
642	642	(1) the 181st day after the disenrollment date; and
643	643	(2) the participant pays any debt accrued due to the
644	644	participant's failure to make the contribution.
645	645	(b) For a participant enrolled in the plus plan whose annual
646	646	household income is equal to or less than 100 percent of the federal
647	647	poverty level and who fails to make a contribution in accordance
648	648	with Section 537A.0252, the commission shall disenroll the
649	649	participant from the plus plan and enroll the participant in the
650	650	basic plan. A participant enrolled in the basic plan under this
651	651	subsection may not change enrollment to the plus plan until the
652	652	participant's program eligibility is redetermined.
653	653	SUBCHAPTER G. EMPLOYMENT INITIATIVE
654	654	Sec. 537A.0301. GATEWAY TO WORK PROGRAM. (a) The
655	655	commission shall develop and implement a gateway to work program
656	656	to:
657	657	(1) integrate existing job training and job search
658	658	programs available in this state through the Texas Workforce
659	659	Commission or other appropriate state agencies with the Live Well
660	660	Texas program; and
661	661	(2) provide each participant with general information
662	662	on the job training and job search programs.
663	663	(b) Under the gateway to work program, the commission shall
664	664	refer each participant who is unemployed or working less than 20
665	665	hours a week to available job search and job training programs.
666	666	SUBCHAPTER H. HEALTH CARE FINANCIAL ASSISTANCE FOR CERTAIN
667	667	PARTICIPANTS
668	668	Sec. 537A.0351. HEALTH CARE FINANCIAL ASSISTANCE FOR
669	669	CONTINUITY OF CARE. (a) The commission shall ensure continuity of
670	670	care by providing health care financial assistance in accordance
671	671	with and in the manner described by this subchapter for a
672	672	participant who:
673	673	(1) the commission disenrolls from a program health
674	674	benefit plan in accordance with Section 537A.0155 because the
675	675	participant's annual household income exceeds the income
676	676	eligibility requirements for enrollment in a program health benefit
677	677	plan; and
678	678	(2) seeks and obtains private health benefit coverage
679	679	within 12 months following the date of disenrollment.
680	680	(b) To receive health care financial assistance under this
681	681	subchapter, a participant must provide to the commission, in the
682	682	form and manner the commission requires, documentation showing the
683	683	participant has obtained or is actively seeking private health
684	684	benefit coverage.
685	685	(c) The commission may not impose an upper income
686	686	eligibility limit on a participant to receive health care financial
687	687	assistance under this subchapter.
688	688	Sec. 537A.0352. DURATION AND AMOUNT OF HEALTH CARE
689	689	FINANCIAL ASSISTANCE. (a) A participant described by Section
690	690	537A.0351 may receive health care financial assistance under this
691	691	subchapter until the first anniversary of the date the commission
692	692	disenrolled the participant from a program health benefit plan.
693	693	(b) Health care financial assistance the commission makes
694	694	available to a participant under this subchapter:
695	695	(1) may not exceed the amount described by Section
696	696	537A.0353; and
697	697	(2) may be used only to pay for eligible services
698	698	described by Section 537A.0354.
699	699	Sec. 537A.0353. BRIDGE ACCOUNT; FUNDING. (a) The
700	700	commission shall establish a bridge account for each participant
701	701	eligible to receive health care financial assistance under Section
702	702	537A.0351. The account is funded with money the commission
703	703	contributes in accordance with this section.
704	704	(b) The commission shall enable each participant for whom
705	705	the commission establishes a bridge account to access and manage
706	706	money in and information regarding the participant's account
707	707	through an electronic system. The commission may contract with the
708	708	same entity described by Section 537A.0251(b) or another entity
709	709	with appropriate experience and expertise to establish, implement,
710	710	or administer the electronic system.
711	711	(c) The commission shall fund each bridge account in an
712	712	amount equal to $1,000 using money the commission retains or
713	713	recoups:
714	714	(1) during the roll over process described by Section
715	715	537A.0256;
716	716	(2) following the issuance of a refund as described by
717	717	Section 537A.0257; or
718	718	(3) under Subsection (e).
719	719	(d) The commission may not require a participant to
720	720	contribute money to the participant's bridge account.
721	721	(e) The commission shall retain or recoup any unexpended
722	722	money in a participant's bridge account at the end of the period for
723	723	which the participant is eligible to receive health care financial
724	724	assistance under this subchapter for the purpose of funding another
725	725	participant's POWER account under Subchapter F or bridge account
726	726	under this subchapter.
727	727	Sec. 537A.0354. USE OF BRIDGE ACCOUNT MONEY. (a) The
728	728	commission shall issue to each participant for whom the commission
729	729	establishes a bridge account an electronic payment card that allows
730	730	the participant to use the card to pay costs for eligible services
731	731	described by Subsection (b).
732	732	(b) A participant may use money in the participant's bridge
733	733	account to pay:
734	734	(1) premium costs incurred during the private health
735	735	benefit coverage enrollment process and coverage period; and
736	736	(2) copayments, deductible costs, and coinsurance
737	737	associated with the private health benefit coverage the participant
738	738	obtains for health care services that would otherwise be
739	739	reimbursable under Medicaid.
740	740	(c) Costs described by Subsection (b)(2) associated with
741	741	eligible services delivered to a participant may be paid by:
742	742	(1) a participant using the electronic payment card
743	743	issued under Subsection (a); or
744	744	(2) a health care provider directly charging and
745	745	receiving payment from the participant's bridge account.
746	746	Sec. 537A.0355. ENROLLMENT COUNSELING. The commission
747	747	shall provide enrollment counseling to an individual who is seeking
748	748	private health benefit coverage and who is otherwise eligible to
749	749	receive health care financial assistance under this subchapter.
750	750	CHAPTER 537B. EXPANDED MEDICAID ELIGIBILITY FOR CERTAIN
751	751	INDIVIDUALS
752	752	Sec. 537B.0001. APPLICABILITY. This chapter applies only
753	753	to an individual who would be eligible to participate in the Live
754	754	Well Texas program under Chapter 537A based on the eligibility
755	755	requirements described by Section 537A.0151, if the commission were
756	756	to establish the program.
757	757	Sec. 537B.0002. EXPANDED MEDICAID ELIGIBILITY UNDER
758	758	PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a) Except as provided
759	759	by Subsection (b) and notwithstanding any other law, the commission
760	760	shall provide Medicaid benefits to all individuals who apply for
761	761	those benefits and to whom this chapter applies.
762	762	(b) After the waiver described by Section 537A.0051 is
763	763	approved and the commission implements the Live Well Texas program
764	764	under Chapter 537A, the commission shall:
765	765	(1) provide health benefit coverage through that
766	766	program in accordance with Chapter 537A to individuals to whom this
767	767	chapter applies; and
768	768	(2) cease providing Medicaid benefits to those
769	769	individuals, except as provided by Chapter 537A.
770	770	(c) The commission shall:
771	771	(1) continue to provide Medicaid benefits to
772	772	individuals described by Subsection (a) if the waiver described by
773	773	Section 537A.0051 is not approved; and
774	774	(2) resume providing Medicaid benefits to individuals
775	775	described by Subsection (a) if the Live Well Texas program
776	776	implemented under Chapter 537A terminates in accordance with
777	777	Section 537A.0053(b).
778	778	(d) The executive commissioner shall adopt rules regarding
779	779	the provision of Medicaid benefits as required by this section,
780	780	including, as applicable, rules on transitioning individuals from
781	781	receiving Medicaid benefits under this section to receiving health
782	782	benefit coverage under the Live Well Texas program implemented
783	783	under Chapter 537A.
784	784	SECTION 2. As soon as practicable after the effective date
785	785	of this Act, the executive commissioner of the Health and Human
786	786	Services Commission shall apply for and actively pursue from the
787	787	federal Centers for Medicare and Medicaid Services or another
788	788	appropriate federal agency the waiver as required by Section
789	789	537A.0051, Government Code, as added by this Act. The commission
790	790	may delay implementing other provisions of Chapter 537A, Government
791	791	Code, as added by this Act, until the waiver applied for under that
792	792	section is granted.
793	793	SECTION 3. (a) Chapter 537B, Government Code, as added by
794	794	this Act, applies only to an initial determination or
795	795	recertification of an individual's Medicaid eligibility under
796	796	Chapter 32, Human Resources Code, made on or after the
797	797	implementation of Chapter 537B, regardless of the date the
798	798	individual applied for Medicaid.
799	799	(b) As soon as practicable after the effective date of this
800	800	Act, the executive commissioner of the Health and Human Services
801	801	Commission shall take all necessary actions to expand Medicaid
802	802	eligibility in accordance with Chapter 537B, Government Code, as
803	803	added by this Act, including notifying appropriate federal agencies
804	804	of that expanded eligibility. If before implementing Chapter 537B
805	805	a state agency determines that any other waiver or authorization
806	806	from a federal agency is necessary for implementation of that
807	807	chapter, the agency affected by the chapter shall request the
808	808	waiver or authorization and may delay implementing that chapter
809	809	until the waiver or authorization is granted.
810	810	SECTION 4. This Act takes effect immediately if it receives
811	811	a vote of two-thirds of all the members elected to each house, as
812	812	provided by Section 39, Article III, Texas Constitution. If this
813	813	Act does not receive the vote necessary for immediate effect, this
814	814	Act takes effect September 1, 2023.