Texas 2023 - 88th Regular

Texas Senate Bill SB504 Compare Versions

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1	1	88R4145 BDP-F
2	2	By: Miles S.B. No. 504
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a "Texas solution" 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	requiring a fee.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	ARTICLE 1. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
14	14	SECTION 1.01. Subtitle I, Title 4, Government Code, is
15	15	amended by adding Chapter 540 to read as follows:
16	16	CHAPTER 540. BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
17	17	SUBCHAPTER A. GENERAL PROVISIONS
18	18	Sec. 540.0001. DEFINITIONS. Notwithstanding Section
19	19	531.001, in this chapter:
20	20	(1) "Health benefit exchange" means an American Health
21	21	Benefit Exchange administered by the federal government or an
22	22	exchange created under Section 1311(b) of the Patient Protection
23	23	and Affordable Care Act (42 U.S.C. Section 18031(b)).
24	24	(2) "Medicaid program" means the medical assistance
25	25	program established and operated under Title XIX, Social Security
26	26	Act (42 U.S.C. Section 1396 et seq.).
27	27	(3) "State Medicaid program" means the medical
28	28	assistance program provided by this state under the Medicaid
29	29	program.
30	30	Sec. 540.0002. FEDERAL AUTHORIZATION TO REFORM MEDICAID
31	31	REQUIRED. If the federal government establishes, through
32	32	conversion or otherwise, a block grant funding system for the
33	33	Medicaid program or otherwise authorizes the state Medicaid program
34	34	to operate under a block grant funding system, including under a
35	35	Medicaid program waiver, the commission, in cooperation with
36	36	applicable health and human services agencies, shall, subject to
37	37	Section 540.0003, administer and operate the state Medicaid program
38	38	in accordance with this chapter.
39	39	Sec. 540.0003. CONFLICT WITH OTHER LAW. To the extent of a
40	40	conflict between a provision of this chapter and:
41	41	(1) another provision of state law, the provision of
42	42	this chapter controls, subject to Section 540A.0002(b); and
43	43	(2) a provision of federal law or any authorization
44	44	described under Section 540.0002, the federal law or authorization
45	45	controls.
46	46	Sec. 540.0004. ESTABLISHMENT OF REFORMED STATE MEDICAID
47	47	PROGRAM. The commission shall establish a state Medicaid program
48	48	that provides benefits under a risk-based Medicaid managed care
49	49	model.
50	50	Sec. 540.0005. RULES. The executive commissioner shall
51	51	adopt rules necessary to implement this chapter.
52	52	SUBCHAPTER B. ACUTE CARE
53	53	Sec. 540.0051. ELIGIBILITY FOR MEDICAID ACUTE CARE. (a) An
54	54	individual is eligible to receive acute care benefits under the
55	55	state Medicaid program if the individual:
56	56	(1) has a household income at or below 100 percent of
57	57	the federal poverty level;
58	58	(2) is under 19 years of age and:
59	59	(A) is receiving Supplemental Security Income
60	60	(SSI) under 42 U.S.C. Section 1381 et seq.; or
61	61	(B) is in foster care or resides in another
62	62	residential care setting under the conservatorship of the
63	63	Department of Family and Protective Services; or
64	64	(3) meets the eligibility requirements that were in
65	65	effect in this state on August 31, 2023.
66	66	(b) The commission shall provide acute care benefits under
67	67	the state Medicaid program to each individual eligible under this
68	68	section through the most cost-effective means, as determined by the
69	69	commission.
70	70	(c) If an individual is not eligible for the state Medicaid
71	71	program under Subsection (a), the commission shall refer the
72	72	individual to the program established under Chapter 540A that helps
73	73	connect eligible residents with health benefit plan coverage
74	74	through private market solutions, a health benefit exchange, or any
75	75	other resource the commission determines appropriate.
76	76	Sec. 540.0052. MEDICAID SLIDING SCALE SUBSIDIES. (a) An
77	77	individual who is eligible for the state Medicaid program under
78	78	Section 540.0051 may receive a Medicaid sliding scale subsidy to
79	79	purchase a health benefit plan from an authorized health benefit
80	80	plan issuer.
81	81	(b) A sliding scale subsidy provided to an individual under
82	82	this section must:
83	83	(1) be based on:
84	84	(A) the average premium in the market; and
85	85	(B) a realistic assessment of the individual's
86	86	ability to pay a portion of the premium; and
87	87	(2) include an enhancement for individuals who choose
88	88	a high deductible health plan with a health savings account.
89	89	(c) The commission shall ensure that counselors are made
90	90	available to individuals receiving a subsidy to advise the
91	91	individuals on selecting a health benefit plan that meets the
92	92	individuals' needs.
93	93	(d) An individual receiving a subsidy under this section is
94	94	responsible for paying:
95	95	(1) any difference between the premium costs
96	96	associated with the purchase of a health benefit plan and the amount
97	97	of the individual's subsidy under this section; and
98	98	(2) any copayments associated with the health benefit
99	99	plan, except to the extent the individual receives an additional
100	100	subsidy under Section 540.0053 to pay the copayments.
101	101	(e) If the amount of a subsidy received by an individual
102	102	under this section exceeds the premium costs associated with the
103	103	individual's purchase of a health benefit plan, the individual may
104	104	deposit the excess amount in a health savings account that may be
105	105	used only in the manner described by Section 540.0054(b).
106	106	Sec. 540.0053. ADDITIONAL COST-SHARING SUBSIDIES. In
107	107	addition to providing a subsidy to an individual under Section
108	108	540.0052, the commission shall provide additional subsidies for
109	109	coinsurance payments, copayments, deductibles, and other
110	110	cost-sharing requirements associated with the individual's health
111	111	benefit plan. The commission shall provide the additional
112	112	subsidies on a sliding scale based on income.
113	113	Sec. 540.0054. DELIVERY OF SUBSIDIES; HEALTH SAVINGS
114	114	ACCOUNTS. (a) The commission shall determine the most appropriate
115	115	manner for delivering and administering subsidies provided under
116	116	Sections 540.0052 and 540.0053. In determining the most
117	117	appropriate manner, the commission shall consider depositing
118	118	subsidy amounts for an individual in a health savings account
119	119	established for that individual.
120	120	(b) A health savings account established under this section
121	121	may be used only to:
122	122	(1) pay health benefit plan premiums and cost-sharing
123	123	amounts; and
124	124	(2) if appropriate, purchase health care-related
125	125	goods and services.
126	126	Sec. 540.0055. MEDICAID HEALTH BENEFIT PLAN ISSUERS AND
127	127	MINIMUM COVERAGE. The commission shall allow any health benefit
128	128	plan issuer authorized to write health benefit plans in this state
129	129	to participate in the state Medicaid program. The commission in
130	130	consultation with the commissioner of insurance shall establish
131	131	minimum coverage requirements for a health benefit plan to be
132	132	eligible for purchase under the state Medicaid program, subject to
133	133	the requirements specified by this chapter.
134	134	Sec. 540.0056. REINSURANCE FOR PARTICIPATING HEALTH
135	135	BENEFIT PLAN ISSUERS. (a) The commission in consultation with the
136	136	commissioner of insurance shall study a reinsurance program to
137	137	reinsure participating health benefit plan issuers.
138	138	(b) In examining options for a reinsurance program, the
139	139	commission and the commissioner of insurance shall consider a plan
140	140	design under which:
141	141	(1) a participating health benefit plan is not charged
142	142	a premium for the reinsurance; and
143	143	(2) the health benefit plan issuer retains risk on a
144	144	sliding scale.
145	145	SUBCHAPTER C. LONG-TERM SERVICES AND SUPPORTS
146	146	Sec. 540.0101. PLAN TO REFORM DELIVERY OF LONG-TERM
147	147	SERVICES AND SUPPORTS. The commission shall develop a
148	148	comprehensive plan to reform the delivery of long-term services and
149	149	supports that is designed to achieve the following objectives under
150	150	the state Medicaid program or any other program created as an
151	151	alternative to the state Medicaid program:
152	152	(1) encourage consumer direction;
153	153	(2) simplify and streamline the provision of services;
154	154	(3) provide flexibility to design benefits packages
155	155	that meet the needs of individuals receiving long-term services and
156	156	supports under the program;
157	157	(4) improve the cost-effectiveness and sustainability
158	158	of the provision of long-term services and supports;
159	159	(5) reduce reliance on institutional settings; and
160	160	(6) encourage cost-sharing by family members when
161	161	appropriate.
162	162	ARTICLE 2. IMMEDIATE REFORM: PROGRAM TO ENSURE HEALTH BENEFIT
163	163	COVERAGE FOR CERTAIN INDIVIDUALS THROUGH PRIVATE MARKETPLACE
164	164	SECTION 2.01. Subtitle I, Title 4, Government Code, is
165	165	amended by adding Chapter 540A to read as follows:
166	166	CHAPTER 540A. PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR
167	167	CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS
168	168	SUBCHAPTER A. GENERAL PROVISIONS
169	169	Sec. 540A.0001. DEFINITION. In this chapter, "state
170	170	Medicaid program" has the meaning assigned by Section 540.0001.
171	171	Sec. 540A.0002. CONFLICT WITH OTHER LAW. (a) Except as
172	172	provided by Subsection (b), to the extent of a conflict between a
173	173	provision of this chapter and:
174	174	(1) another provision of state law, the provision of
175	175	this chapter controls; and
176	176	(2) a provision of federal law or any authorization
177	177	described under Subchapter B, the federal law or authorization
178	178	controls.
179	179	(b) The program operated under this chapter is in addition
180	180	to the state Medicaid program operated under Chapter 32, Human
181	181	Resources Code, or under a block grant funding system under Chapter
182	182	540.
183	183	Sec. 540A.0003. PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE
184	184	THROUGH PRIVATE MARKET SOLUTIONS. Subject to the requirements of
185	185	this chapter, the commission in consultation with the commissioner
186	186	of insurance shall develop and implement a program that helps
187	187	connect certain low-income residents of this state with health
188	188	benefit plan coverage through private market solutions.
189	189	Sec. 540A.0004. NOT AN ENTITLEMENT. This chapter does not
190	190	establish an entitlement to assistance in obtaining health benefit
191	191	plan coverage.
192	192	Sec. 540A.0005. RULES. The executive commissioner shall
193	193	adopt rules necessary to implement this chapter.
194	194	SUBCHAPTER B. FEDERAL AUTHORIZATION
195	195	Sec. 540A.0051. FEDERAL AUTHORIZATION FOR FLEXIBILITY TO
196	196	ESTABLISH PROGRAM. (a) The commission in consultation with the
197	197	commissioner of insurance shall negotiate with the United States
198	198	secretary of health and human services, the Centers for Medicare
199	199	and Medicaid Services, and other appropriate persons for purposes
200	200	of seeking a waiver or other authorization necessary to obtain the
201	201	flexibility to use federal matching funds to help provide, in
202	202	accordance with Subchapter C, health benefit plan coverage to
203	203	certain low-income individuals through private market solutions.
204	204	(b) Any agreement reached under this section must:
205	205	(1) create a program that is made cost neutral to this
206	206	state by:
207	207	(A) leveraging premium tax revenues; and
208	208	(B) achieving cost savings through offsets to
209	209	general revenue health care costs or the implementation of other
210	210	cost savings mechanisms;
211	211	(2) create more efficient health benefit plan coverage
212	212	options for eligible individuals through:
213	213	(A) program changes that may be made without the
214	214	need for additional federal approval; and
215	215	(B) program changes that require additional
216	216	federal approval;
217	217	(3) require the commission to achieve efficiency and
218	218	reduce unnecessary utilization, including duplication, of health
219	219	care services;
220	220	(4) be designed with the goals of:
221	221	(A) relieving local tax burdens;
222	222	(B) reducing general revenue reliance so as to
223	223	make general revenue available for other state priorities; and
224	224	(C) minimizing the impact of any federal health
225	225	care laws on Texas-based businesses; and
226	226	(5) afford this state the opportunity to develop a
227	227	state-specific solution with benefits that specifically meet the
228	228	unique needs of this state's population.
229	229	(c) An agreement reached under this section may be:
230	230	(1) limited in duration; and
231	231	(2) contingent on continued funding by the federal
232	232	government.
233	233	SUBCHAPTER C. PROGRAM REQUIREMENTS
234	234	Sec. 540A.0101. ENROLLMENT ELIGIBILITY. (a) Subject to
235	235	Subsection (b), an individual may be eligible to enroll in a program
236	236	designed and established under this chapter if the person:
237	237	(1) is younger than 65;
238	238	(2) has a household income at or below 133 percent of
239	239	the federal poverty level; and
240	240	(3) is not otherwise eligible to receive benefits
241	241	under the state Medicaid program, including through a program
242	242	operated under Chapter 32, Human Resources Code, or under Chapter
243	243	540 through a block grant funding system or a waiver, other than a
244	244	waiver granted under this chapter, to the program.
245	245	(b) The executive commissioner may modify or further define
246	246	the eligibility requirements of this section if the commission
247	247	determines it necessary to reach an agreement under Subchapter B.
248	248	Sec. 540A.0102. MINIMUM PROGRAM REQUIREMENTS. A program
249	249	designed and established under this chapter must:
250	250	(1) if cost-effective for this state, provide premium
251	251	assistance to purchase health benefit plan coverage in the private
252	252	market, including health benefit plan coverage offered through a
253	253	managed care delivery model;
254	254	(2) provide enrollees with access to health benefits,
255	255	including benefits provided through a managed care delivery model,
256	256	that:
257	257	(A) are tailored to the enrollees;
258	258	(B) provide levels of coverage that are
259	259	customized to meet health care needs of individuals within defined
260	260	categories of the enrolled population; and
261	261	(C) emphasize personal responsibility and
262	262	accountability through flexible and meaningful cost-sharing
263	263	requirements and wellness initiatives, including through
264	264	incentives for compliance with health, wellness, and treatment
265	265	strategies and disincentives for noncompliance;
266	266	(3) include pay-for-performance initiatives for
267	267	private health benefit plan issuers that participate in the
268	268	program;
269	269	(4) use technology to maximize the efficiency with
270	270	which the commission and any health benefit plan issuer, health
271	271	care provider, or managed care organization participating in the
272	272	program manage enrollee participation;
273	273	(5) allow recipients under the state Medicaid program
274	274	to enroll in the program to receive premium assistance as an
275	275	alternative to the state Medicaid program;
276	276	(6) encourage eligible individuals to enroll in other
277	277	private or employer-sponsored health benefit plan coverage, if
278	278	available and appropriate;
279	279	(7) encourage the utilization of health care services
280	280	in the most appropriate low-cost settings; and
281	281	(8) establish health savings accounts for enrollees,
282	282	as appropriate.
283	283	SECTION 2.02. The Health and Human Services Commission in
284	284	consultation with the commissioner of insurance and the Medicaid
285	285	Reform Task Force established under Article 4 of this Act shall
286	286	actively develop a proposal for the authorization from the
287	287	appropriate federal entity as required by Subchapter B, Chapter
288	288	540A, Government Code, as added by this article. As soon as
289	289	possible after the effective date of this Act, the Health and Human
290	290	Services Commission shall request and actively pursue obtaining the
291	291	authorization from the appropriate federal entity.
292	292	ARTICLE 3. MEDICAID: INCREMENTAL REFORM
293	293	SECTION 3.01. Subchapter B, Chapter 531, Government Code,
294	294	is amended by adding Section 531.0974 to read as follows:
295	295	Sec. 531.0974. CUSTOMIZED BENEFITS PACKAGE. The commission
296	296	shall, for individuals receiving home and community-based services
297	297	and supports instead of institutional long-term services and
298	298	supports, develop and implement customized benefits packages that
299	299	are designed to prevent the overutilization of services.
300	300	Customized benefits packages under this section must be based on an
301	301	individualized needs assessment administered at a single point of
302	302	entry.
303	303	SECTION 3.02. Subchapter B, Chapter 32, Human Resources
304	304	Code, is amended by adding Sections 32.0501, 32.0642, and 32.078 to
305	305	read as follows:
306	306	Sec. 32.0501. DUAL ELIGIBLE INTEGRATED CARE DEMONSTRATION
307	307	PROJECT. (a) In this section:
308	308	(1) "ICF-IID" has the meaning assigned by Section
309	309	531.002, Health and Safety Code.
310	310	(2) "Nursing facility" has the meaning assigned by
311	311	Section 531.912, Government Code.
312	312	(3) "State supported living center" has the meaning
313	313	assigned by Section 531.002, Health and Safety Code.
314	314	(b) Subject to Subsection (c), the commission shall
315	315	establish a dual eligible integrated care demonstration project
316	316	that would allow appropriate individuals described by Section
317	317	32.050(a), as determined by the commission, to receive long-term
318	318	services and supports under both the medical assistance program and
319	319	the Medicare program through a single managed care plan.
320	320	(c) An individual who is a resident of a nursing facility,
321	321	ICF-IID, or state supported living center is exempt from
322	322	participation in the demonstration project.
323	323	Sec. 32.0642. PARENTAL FEE PROGRAM. (a) To the extent
324	324	allowed by federal law, the commission shall establish a parental
325	325	fee program that requires the parent or legal guardian of a child
326	326	receiving institutional long-term services and supports or home and
327	327	community-based services and supports under the medical assistance
328	328	program established under this chapter to pay a fee that:
329	329	(1) correlates with the services and supports
330	330	provided; and
331	331	(2) takes into consideration the child's household
332	332	income.
333	333	(b) Failure to pay a fee under this section may not affect a
334	334	child's eligibility for benefits under the medical assistance
335	335	program.
336	336	(c) The executive commissioner shall adopt rules necessary
337	337	to implement this section.
338	338	Sec. 32.078. HOUSING BENEFITS FOR CERTAIN RECIPIENTS. To
339	339	the extent allowed by federal law, the commission shall provide
340	340	housing payment assistance for recipients receiving home and
341	341	community-based services and supports under the medical assistance
342	342	program established under this chapter.
343	343	SECTION 3.03. (a) The Health and Human Services Commission
344	344	shall conduct a study to examine the estate recovery program
345	345	implemented by this state under 42 U.S.C. Section 1396p(b)(1) and
346	346	determine options the state has to improve recovery under and
347	347	increase the efficacy of the program.
348	348	(b) Not later than December 1, 2024, the commission shall
349	349	submit a written report containing the findings of the study
350	350	conducted under this section together with the commission's
351	351	recommendations to the governor, the lieutenant governor, and the
352	352	standing committees of the senate and house of representatives
353	353	having primary jurisdiction over Medicaid.
354	354	SECTION 3.04. (a) The Health and Human Services Commission
355	355	shall conduct a study on imposing alternative income and asset
356	356	limits for purposes of determining eligibility for long-term
357	357	services and supports under the medical assistance program under
358	358	Chapter 32, Human Resources Code. The commission shall consider:
359	359	(1) imposing greater restrictions on exempt assets;
360	360	(2) limiting the amount of income that an individual
361	361	may transfer into a qualified trust under 42 U.S.C. Section
362	362	1396p(d)(4)(B) to an amount equal to the average cost of nursing
363	363	home care; and
364	364	(3) reducing the income eligibility limit to qualify
365	365	for Medicaid institutional long-term services and supports or home
366	366	and community-based waiver services under the medical assistance
367	367	program under Chapter 32, Human Resources Code.
368	368	(b) Not later than December 1, 2024, the commission shall
369	369	submit a written report containing the findings of the study
370	370	conducted under this section together with the commission's
371	371	recommendations to the governor, the lieutenant governor, and the
372	372	standing committees of the senate and house of representatives
373	373	having primary jurisdiction over Medicaid.
374	374	ARTICLE 4. MEDICAID REFORM TASK FORCE
375	375	SECTION 4.01. (a) In this section:
376	376	(1) "Commission" means the Health and Human Services
377	377	Commission.
378	378	(2) "Medicaid program" and "state Medicaid program"
379	379	have the meanings assigned by Section 540.0001, Government Code, as
380	380	added by this Act.
381	381	(3) "Task force" means the Medicaid Reform Task Force
382	382	established under this section.
383	383	(b) The Medicaid Reform Task Force is established for
384	384	purposes of advising the commission in designing a state Medicaid
385	385	program and a program for ensuring health benefit plan coverage for
386	386	low-income individuals that are:
387	387	(1) consistent with Articles 2 and 3 of this Act; and
388	388	(2) if the federal government establishes a block
389	389	grant funding system in accordance with Section 540.0002,
390	390	Government Code, as added by this Act, consistent with Article 1 of
391	391	this Act.
392	392	(c) The task force consists of 12 members appointed as
393	393	follows:
394	394	(1) one member appointed by the governor;
395	395	(2) two members of the senate appointed by the
396	396	lieutenant governor;
397	397	(3) two members of the house of representatives
398	398	appointed by the speaker of the house of representatives;
399	399	(4) one member of the Senate Committee on Finance,
400	400	appointed by the presiding officer;
401	401	(5) one member of the House Appropriations Committee,
402	402	appointed by the presiding officer;
403	403	(6) one member of the Senate Committee on Health and
404	404	Human Services, appointed by the presiding officer;
405	405	(7) one member of the House Public Health Committee,
406	406	appointed by the presiding officer;
407	407	(8) the executive commissioner of the commission or
408	408	the executive commissioner's designee;
409	409	(9) the commissioner of insurance or the
410	410	commissioner's designee to represent the Texas Department of
411	411	Insurance; and
412	412	(10) the director of the Legislative Budget Board or
413	413	the director's designee.
414	414	(d) The lieutenant governor and the speaker of the house of
415	415	representatives shall each appoint a member of the task force to act
416	416	as co-presiding officers.
417	417	(e) A member of the task force serves without compensation.
418	418	(f) Not later than January 1, 2024, the appropriate
419	419	appointing officers shall appoint the members of the task force.
420	420	(g) Not later than December 1, 2024, the task force shall
421	421	submit a report to the legislature regarding its activities under
422	422	this section.
423	423	(h) This section expires September 1, 2025.
424	424	ARTICLE 5. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
425	425	SECTION 5.01. Subject to Section 2.02 of this Act, if before
426	426	implementing any provision of this Act a state agency determines
427	427	that a waiver or authorization from a federal agency is necessary
428	428	for implementation of that provision, the agency affected by the
429	429	provision shall request the waiver or authorization and may delay
430	430	implementing that provision until the waiver or authorization is
431	431	granted.
432	432	SECTION 5.02. This Act takes effect September 1, 2023.