Texas 2025 - 89th Regular

Texas Senate Bill SB232 Compare Versions

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1	1	2023S0003-1 11/08/24
2	2	By: Johnson S.B. No. 232
3	3
4	4
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the development and implementation of the Live Well
10	10	Texas program and the expansion of Medicaid eligibility to provide
11	11	health benefit coverage to certain individuals; imposing
12	12	penalties.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Subtitle I, Title 4, Government Code, is amended
15	15	by adding Chapters 537A and 537B to read as follows:
16	16	CHAPTER 537A. LIVE WELL TEXAS PROGRAM
17	17	SUBCHAPTER A. GENERAL PROVISIONS
18	18	Sec. 537A.0001. DEFINITIONS. In this chapter:
19	19	(1) "Basic plan" means the program health benefit plan
20	20	described by Section 537A.0202.
21	21	(2) "Eligible individual" means an individual who is
22	22	eligible to participate in the program.
23	23	(3) "Health Savings Account" means a personal wellness
24	24	and responsibility account the commission establishes for a
25	25	participant under Section 537A.0251.
26	26	(4) "Participant" means an individual who is:
27	27	(A) enrolled in a program health benefit plan; or
28	28	(B) receiving health care financial assistance
29	29	under Subchapter H.
30	30	(5) "Plus plan" means the program health benefit plan
31	31	described by Section 537A.0203.
32	32	(6) "Program" means the Live Well Texas program
33	33	established under this chapter.
34	34	(7) "Program health benefit plan" includes:
35	35	(A) the basic plan; and
36	36	(B) the plus plan.
37	37	(8) "Program health benefit plan provider" means a
38	38	health benefit plan provider that contracts with the commission
39	39	under Section 537A.0107 to arrange for the provision of health care
40	40	services through a program health benefit plan.
41	41	SUBCHAPTER B. FEDERAL WAIVER FOR LIVE WELL TEXAS PROGRAM
42	42	Sec. 537A.0051. FEDERAL AUTHORIZATION FOR PROGRAM. (a)
43	43	Notwithstanding any other law, the executive commissioner shall
44	44	develop and seek a waiver under Section 1115 of the Social Security
45	45	Act (42 U.S.C. Section 1315) to the state Medicaid plan to implement
46	46	the Live Well Texas program to assist individuals in obtaining
47	47	health benefit coverage through a program health benefit plan or
48	48	health care financial assistance.
49	49	(b) The terms of a waiver the executive commissioner seeks
50	50	under this section must:
51	51	(1) be designed to:
52	52	(A) provide health benefit coverage options for
53	53	eligible individuals;
54	54	(B) produce better health outcomes for
55	55	participants;
56	56	(C) create incentives for participants to
57	57	transition from receiving public assistance benefits to achieving
58	58	stable employment;
59	59	(D) promote personal responsibility and engage
60	60	participants in making decisions regarding health care based on
61	61	cost and quality;
62	62	(E) support participants' self-sufficiency by
63	63	requiring unemployed participants to be referred to work search and
64	64	job training programs;
65	65	(F) support participants who become ineligible
66	66	to participate in a program health benefit plan in transitioning to
67	67	private health benefit coverage; and
68	68	(G) leverage enhanced federal medical assistance
69	69	percentage funding to minimize or eliminate the need for a program
70	70	enrollment cap; and
71	71	(2) allow for the operation of the program consistent
72	72	with the requirements of this chapter, except to the extent
73	73	deviation from the requirements is necessary to obtain federal
74	74	authorization of the waiver.
75	75	Sec. 537A.0052. FUNDING. Subject to approval of the waiver
76	76	described by Section 537A.0051, the commission shall implement the
77	77	program using enhanced federal medical assistance percentage
78	78	funding available under the Patient Protection and Affordable Care
79	79	Act (Pub. L. No. 111-148) as amended by the Health Care and
80	80	Education Reconciliation Act of 2010 (Pub. L. No. 111-152).
81	81	Sec. 537A.0053. NOT AN ENTITLEMENT; TERMINATION OF PROGRAM.
82	82	(a) This chapter does not establish an entitlement to health
83	83	benefit coverage or health care financial assistance under the
84	84	program for eligible individuals.
85	85	(b) The program terminates at the time the share of federal
86	86	funding for the program under the Patient Protection and Affordable
87	87	Care Act (Pub. L. No. 111-148) as amended by the Health Care and
88	88	Education Reconciliation Act of 2010 (Pub. L. No. 111-152) is
89	89	reduced below 90 percent.
90	90	SUBCHAPTER C. PROGRAM ADMINISTRATION
91	91	Sec. 537A.0101. PROGRAM OBJECTIVE. The program's principal
92	92	objective is to provide primary and preventative health care
93	93	through high deductible program health benefit plans to eligible
94	94	individuals.
95	95	Sec. 537A.0102. PROGRAM PROMOTION. The commission shall
96	96	promote and provide information about the program to individuals
97	97	who:
98	98	(1) are potentially eligible to participate in the
99	99	program; and
100	100	(2) live in medically underserved areas of this state.
101	101	Sec. 537A.0103. COMMISSION'S AUTHORITY RELATED TO HEALTH
102	102	BENEFIT PLAN PROVIDER CONTRACTS. The commission may:
103	103	(1) enter into contracts with health benefit plan
104	104	providers under Section 537A.0107;
105	105	(2) monitor program health benefit plan providers
106	106	through reporting requirements and other means to ensure contract
107	107	performance and quality delivery of services;
108	108	(3) monitor the quality of services delivered to
109	109	participants through outcome measurements; and
110	110	(4) provide payment under the contracts to program
111	111	health benefit plan providers.
112	112	Sec. 537A.0104. COMMISSION'S AUTHORITY RELATED TO
113	113	ELIGIBILITY AND MEDICAID COORDINATION. The commission may:
114	114	(1) accept applications for health benefit coverage
115	115	under the program and implement program eligibility screening and
116	116	enrollment procedures;
117	117	(2) resolve grievances related to eligibility
118	118	determinations; and
119	119	(3) to the extent possible, coordinate the program
120	120	with Medicaid.
121	121	Sec. 537A.0105. THIRD-PARTY ADMINISTRATOR CONTRACT FOR
122	122	PROGRAM IMPLEMENTATION. (a) In administering the program, the
123	123	commission may contract with a third-party administrator to provide
124	124	enrollment and related services.
125	125	(b) If the commission contracts with a third-party
126	126	administrator under this section, the commission may:
127	127	(1) monitor the third-party administrator through
128	128	reporting requirements and other means to ensure contract
129	129	performance and quality delivery of services; and
130	130	(2) provide payment under the contract to the
131	131	third-party administrator.
132	132	(c) The executive commissioner shall retain all
133	133	policymaking authority over the program.
134	134	(d) The commission shall procure each contract with a
135	135	third-party administrator, as applicable, through a competitive
136	136	procurement process that complies with all federal and state laws.
137	137	Sec. 537A.0106. TEXAS DEPARTMENT OF INSURANCE DUTIES. (a)
138	138	At the commission's request, the Texas Department of Insurance
139	139	shall provide any necessary assistance with the program. The
140	140	department shall monitor the quality of the services provided by
141	141	program health benefit plan providers and resolve grievances
142	142	related to those providers.
143	143	(b) The commission and the Texas Department of Insurance may
144	144	adopt a memorandum of understanding that addresses the
145	145	responsibilities of each agency with respect to the program.
146	146	(c) The Texas Department of Insurance, in consultation with
147	147	the commission, shall adopt rules as necessary to implement this
148	148	section.
149	149	Sec. 537A.0107. HEALTH BENEFIT PLAN PROVIDER CONTRACTS.
150	150	The commission shall select through a competitive procurement
151	151	process that complies with all federal and state laws and contract
152	152	with health benefit plan providers to provide health care services
153	153	under the program. To be eligible for a contract under this
154	154	section, an entity must:
155	155	(1) be a Medicaid managed care organization;
156	156	(2) hold a certificate of authority issued by the
157	157	Texas Department of Insurance that authorizes the entity to provide
158	158	the types of health care services offered under the program; and
159	159	(3) satisfy, except as provided by this chapter, any
160	160	applicable requirement of the Insurance Code or another insurance
161	161	law of this state.
162	162	Sec. 537A.0108. HEALTH CARE PROVIDERS. (a) A health care
163	163	provider who provides health care services under the program must
164	164	meet certification and licensure requirements required by
165	165	commission rules and other law.
166	166	(b) In adopting rules governing the program, the executive
167	167	commissioner shall ensure that a health care provider who provides
168	168	health care services under the program is reimbursed at a rate that
169	169	is at least equal to the rate paid under Medicare for the provision
170	170	of the same or substantially similar services.
171	171	Sec. 537A.0109. PROHIBITION ON CERTAIN HEALTH CARE
172	172	PROVIDERS. The executive commissioner shall adopt rules that
173	173	prohibit a health care provider from providing program health care
174	174	services for a reasonable period, as determined by the executive
175	175	commissioner, if the health care provider:
176	176	(1) fails to repay program overpayments; or
177	177	(2) owns, controls, manages, or is otherwise
178	178	affiliated with and has financial, managerial, or administrative
179	179	influence over a health care provider who has been suspended or
180	180	prohibited from providing program health care services.
181	181	SUBCHAPTER D. ELIGIBILITY FOR PROGRAM HEALTH BENEFIT COVERAGE
182	182	Sec. 537A.0151. ELIGIBILITY REQUIREMENTS. (a) An
183	183	individual is eligible to enroll in a program health benefit plan
184	184	if:
185	185	(1) the individual is a resident of this state;
186	186	(2) the individual is 19 years of age or older but
187	187	younger than 65 years of age;
188	188	(3) applying the eligibility criteria in effect in
189	189	this state on December 31, 2024, the individual is not eligible for
190	190	Medicaid; and
191	191	(4) federal matching funds are available under the
192	192	Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
193	193	amended by the Health Care and Education Reconciliation Act of 2010
194	194	(Pub. L. No. 111-152) to provide benefits to the individual under
195	195	the federal medical assistance program established under Title XIX,
196	196	Social Security Act (42 U.S.C. Section 1396 et seq.).
197	197	(b) An individual who is a parent or caretaker relative to
198	198	whom 42 C.F.R. Section 435.110 applies is eligible to enroll in a
199	199	program health benefit plan.
200	200	(c) In determining eligibility for the program, the
201	201	commission shall apply the same eligibility criteria regarding
202	202	residency and citizenship in effect for Medicaid in this state on
203	203	December 31, 2024.
204	204	Sec. 537A.0152. CONTINUOUS COVERAGE. The commission shall
205	205	ensure that an individual who is initially determined or
206	206	redetermined to be eligible to participate in the program and
207	207	enroll in a program health benefit plan will remain eligible for
208	208	coverage under the plan for a period of 12 months beginning on the
209	209	first day of the month following the date eligibility was
210	210	determined or redetermined, subject to Section 537A.0252(f).
211	211	Sec. 537A.0153. APPLICATION FORM AND PROCEDURES. (a) The
212	212	executive commissioner shall adopt an application form and
213	213	application procedures for the program. The form and procedures
214	214	must be coordinated with forms and procedures under Medicaid to
215	215	ensure that there is a single consolidated application process to
216	216	seek health benefit coverage under the program or Medicaid.
217	217	(b) To the extent possible, the commission shall make the
218	218	application form available in languages other than English.
219	219	(c) The executive commissioner may permit an individual to
220	220	apply by mail, over the telephone, or through the Internet.
221	221	Sec. 537A.0154. ELIGIBILITY SCREENING AND ENROLLMENT. (a)
222	222	The executive commissioner shall adopt eligibility screening and
223	223	enrollment procedures or use the Texas Integrated Enrollment
224	224	Services eligibility determination system or a compatible system to
225	225	screen individuals and enroll eligible individuals in the program.
226	226	(b) The eligibility screening and enrollment procedures
227	227	must ensure that an individual applying for the program who appears
228	228	eligible for Medicaid is identified and assisted with obtaining
229	229	Medicaid coverage. If the individual is denied Medicaid coverage
230	230	but is determined eligible to enroll in a program health benefit
231	231	plan, the commission shall enroll the individual in a program
232	232	health benefit plan of the individual's choosing and for which the
233	233	individual is eligible without further application or
234	234	qualification.
235	235	(c) Not later than the 30th day after the date an individual
236	236	submits a complete application form and unless the individual is
237	237	identified and assisted with obtaining Medicaid coverage under
238	238	Subsection (b), the commission shall ensure that the individual's
239	239	eligibility to participate in the program is determined and that
240	240	the individual, if eligible, is provided with information on
241	241	program health benefit plans and program health benefit plan
242	242	providers. The commission shall enroll the individual in the
243	243	program health benefit plan and with the program health benefit
244	244	plan provider of the individual's choosing in a timely manner, as
245	245	determined by the commission.
246	246	(d) The executive commissioner may establish enrollment
247	247	periods for the program.
248	248	Sec. 537A.0155. ELIGIBILITY REDETERMINATION PROCESS;
249	249	DISENROLLMENT. (a) Not later than the 90th day before a
250	250	participant's coverage period expires, the commission shall notify
251	251	the participant regarding the eligibility redetermination process
252	252	and request documentation necessary to redetermine the
253	253	participant's eligibility.
254	254	(b) The commission shall provide written notice of
255	255	termination of eligibility to a participant not later than the 30th
256	256	day before the date the participant's eligibility will terminate.
257	257	The commission shall disenroll the participant from the program if:
258	258	(1) the participant does not submit the requested
259	259	eligibility redetermination documentation before the last day of
260	260	the participant's coverage period; or
261	261	(2) the commission, based on the submitted
262	262	documentation, determines the participant is no longer eligible for
263	263	the program, subject to Subchapter H.
264	264	(c) An individual may submit the requested eligibility
265	265	redetermination documentation not later than the 90th day after the
266	266	date the commission disenrolls the individual from the program. If
267	267	the commission determines that the individual continues to meet
268	268	program eligibility requirements, the commission shall reenroll
269	269	the individual in the program without any additional application
270	270	requirements.
271	271	(d) An individual who does not complete the eligibility
272	272	redetermination process in accordance with this section and who the
273	273	commission disenrolls from the program may not participate in the
274	274	program for a period of 180 days beginning on the date of
275	275	disenrollment. This subsection does not apply to an individual:
276	276	(1) described by Section 537A.0206 or 537A.0208; or
277	277	(2) who is:
278	278	(A) pregnant; or
279	279	(B) younger than 21 years of age.
280	280	(e) At the time the commission disenrolls a participant from
281	281	the program, the commission shall provide to the participant:
282	282	(1) notice that the participant may be eligible to
283	283	receive health care financial assistance under Subchapter H in
284	284	transitioning to private health benefit coverage; and
285	285	(2) information on and the eligibility requirements
286	286	for that financial assistance.
287	287	SUBCHAPTER E. BASIC AND PLUS PLANS
288	288	Sec. 537A.0201. BASIC AND PLUS PLAN COVERAGE GENERALLY.
289	289	(a) The basic and plus plans offered under the program must:
290	290	(1) comply with this subchapter and coverage
291	291	requirements prescribed by other law; and
292	292	(2) at a minimum, provide coverage for essential
293	293	health benefits required under 42 U.S.C. Section 18022(b).
294	294	(b) In modifying covered health benefits under the basic and
295	295	plus plans, the executive commissioner shall consider the health
296	296	care needs of healthy individuals and individuals with special
297	297	health care needs.
298	298	(c) The basic and plus plans must allow a participant with a
299	299	chronic, disabling, or life-threatening illness to select an
300	300	appropriate specialist as the participant's primary care
301	301	physician.
302	302	Sec. 537A.0202. BASIC PLAN: COVERAGE AND INCOME
303	303	ELIGIBILITY. (a) The program must include a basic plan that is
304	304	sufficient to meet the basic health care needs of individuals who
305	305	enroll in the plan.
306	306	(b) The covered health benefits under the basic plan must
307	307	include:
308	308	(1) primary care physician services;
309	309	(2) prenatal and postpartum care;
310	310	(3) specialty care physician visits;
311	311	(4) home health services, not to exceed 100 visits per
312	312	year;
313	313	(5) outpatient surgery;
314	314	(6) allergy testing;
315	315	(7) chemotherapy;
316	316	(8) intravenous infusion services;
317	317	(9) radiation therapy;
318	318	(10) dialysis;
319	319	(11) emergency care hospital services;
320	320	(12) emergency transportation, including ambulance
321	321	and air ambulance;
322	322	(13) urgent care clinic services;
323	323	(14) hospitalization, including for:
324	324	(A) general inpatient hospital care;
325	325	(B) inpatient physician services;
326	326	(C) inpatient surgical services;
327	327	(D) non-cosmetic reconstructive surgery;
328	328	(E) a transplant;
329	329	(F) treatment for a congenital abnormality;
330	330	(G) anesthesia;
331	331	(H) hospice care; and
332	332	(I) care in a skilled nursing facility for a
333	333	period not to exceed 100 days per occurrence;
334	334	(15) inpatient and outpatient behavioral health
335	335	services;
336	336	(16) inpatient, outpatient, and residential substance
337	337	use treatment;
338	338	(17) prescription drugs, including tobacco cessation
339	339	drugs;
340	340	(18) inpatient and outpatient rehabilitative and
341	341	habilitative care, including physical, occupational, and speech
342	342	therapy, not to exceed 60 combined visits per year;
343	343	(19) medical equipment, appliances, and assistive
344	344	technology, including prosthetics and hearing aids, and the repair,
345	345	technical support, and customization needed for individual use;
346	346	(20) laboratory and pathology tests and services;
347	347	(21) diagnostic imaging, including x-rays, magnetic
348	348	resonance imaging, computed tomography, and positron emission
349	349	tomography;
350	350	(22) preventative care services as described by
351	351	Section 537A.0204; and
352	352	(23) services under the early and periodic screening,
353	353	diagnostic, and treatment program for participants who are younger
354	354	than 21 years of age.
355	355	(c) To be eligible for health care benefits under the basic
356	356	plan, an individual who is eligible for the program must have an
357	357	annual household income that is equal to or less than 100 percent of
358	358	the federal poverty level.
359	359	Sec. 537A.0203. PLUS PLAN: COVERAGE AND INCOME ELIGIBILITY.
360	360	(a) The program must include a plus plan that includes the covered
361	361	health benefits listed in Section 537A.0202 and the following
362	362	additional enhanced health benefits:
363	363	(1) services related to the treatment of conditions
364	364	affecting the temporomandibular joint;
365	365	(2) dental care;
366	366	(3) vision care;
367	367	(4) notwithstanding Section 537A.0202(b)(18),
368	368	inpatient and outpatient rehabilitative and habilitative care,
369	369	including physical, occupational, and speech therapy, not to exceed
370	370	75 combined visits per year;
371	371	(5) bariatric surgery; and
372	372	(6) other services the commission considers
373	373	appropriate.
374	374	(b) An individual who is eligible for the program and whose
375	375	annual household income exceeds 100 percent of the federal poverty
376	376	level will automatically be enrolled in and receive health benefits
377	377	under the plus plan. An individual who is eligible for the program
378	378	and whose annual household income is equal to or less than 100
379	379	percent of the federal poverty level may choose to enroll in the
380	380	plus plan.
381	381	(c) A participant enrolled in the plus plan is required to
382	382	make Health Savings Account contributions in accordance with
383	383	Section 537A.0252.
384	384	Sec. 537A.0204. PREVENTATIVE CARE SERVICES. (a) The
385	385	commission shall provide to each participant a list of health care
386	386	services that qualify as preventative care services based on the
387	387	participant's age, gender, and preexisting conditions. In
388	388	developing the list, the commission shall consult with the federal
389	389	Centers for Disease Control and Prevention.
390	390	(b) A program health benefit plan shall, at no cost to the
391	391	participant, provide coverage for:
392	392	(1) preventative care services described by 42 U.S.C.
393	393	Section 300gg-13; and
394	394	(2) a maximum of $500 per year of preventative care
395	395	services other than those described by Subdivision (1).
396	396	(c) A participant who receives preventative care services
397	397	not described by Subsection (b) that are covered under the
398	398	participant's program health benefit plan is subject to deductible
399	399	and copayment requirements for the services in accordance with the
400	400	terms of the plan.
401	401	Sec. 537A.0205. COPAYMENTS. (a) A participant enrolled in
402	402	the basic plan shall pay a copayment for each covered health benefit
403	403	except for a preventative care or family planning service. The
404	404	executive commissioner by rule shall adopt a copayment schedule for
405	405	basic plan services, subject to Subsection (c).
406	406	(b) Except as provided by Subsection (c), a participant
407	407	enrolled in the plus plan may not be required to pay a copayment for
408	408	a covered service.
409	409	(c) A participant enrolled in the basic or plus plan shall
410	410	pay a copayment in an amount set by commission rule not to exceed
411	411	$25 for nonemergency use of hospital emergency department services
412	412	unless:
413	413	(1) the participant has met the cost-sharing maximum
414	414	for the calendar quarter, as prescribed by commission rule;
415	415	(2) the participant is referred to the hospital
416	416	emergency department by a health care provider;
417	417	(3) the visit is a true emergency, as defined by
418	418	commission rule; or
419	419	(4) the participant is pregnant.
420	420	Sec. 537A.0206. CERTAIN PARTICIPANTS ELIGIBLE FOR STATE
421	421	MEDICAID PLAN BENEFITS. (a) A participant described by 42 C.F.R.
422	422	Section 440.315 who is enrolled in the basic or plus plan is
423	423	entitled to receive under the program all health benefits that
424	424	would be available under the state Medicaid plan.
425	425	(b) A participant to which this section applies is subject
426	426	to the cost-sharing requirements, including copayment and Health
427	427	Savings Account contribution requirements, of the program health
428	428	benefit plan in which the participant is enrolled.
429	429	(c) The commission shall develop screening measures to
430	430	identify participants to which this section applies.
431	431	Sec. 537A.0207. PREGNANT PARTICIPANTS. (a) A participant
432	432	who becomes pregnant while enrolled in the program and who meets the
433	433	eligibility requirements for Medicaid may choose to remain in the
434	434	program or enroll in Medicaid.
435	435	(b) A pregnant participant described by Subsection (a) who
436	436	is enrolled in the basic or plus plan and who remains in the program
437	437	is:
438	438	(1) notwithstanding Section 537A.0205, not subject to
439	439	any cost-sharing requirements, including copayment and Health
440	440	Savings Account contribution requirements, of the program health
441	441	benefit plan in which the participant is enrolled until the
442	442	expiration of the second month following the month in which the
443	443	pregnancy ends;
444	444	(2) entitled to receive as a Medicaid wrap-around
445	445	benefit all Medicaid services a pregnant woman enrolled in Medicaid
446	446	is entitled to receive, including a pharmacy benefit, when the
447	447	participant exceeds coverage limits under the participant's
448	448	program health benefit plan or if a service is not covered by the
449	449	plan; and
450	450	(3) eligible for additional vision and dental care
451	451	benefits.
452	452	Sec. 537A.0208. PARENTS AND CARETAKER RELATIVES. (a) A
453	453	parent or caretaker relative to whom 42 C.F.R. Section 435.110
454	454	applies is entitled to receive as a Medicaid wrap-around benefit
455	455	all Medicaid services to which the individual would be entitled
456	456	under the state Medicaid plan that are not covered under the
457	457	individual's program health benefit plan or exceed the plan's
458	458	coverage limits.
459	459	(b) An individual described by Subsection (a) who chooses to
460	460	participate in the program is subject to the cost-sharing
461	461	requirements, including copayment and Health Savings Account
462	462	contribution requirements, of the program health benefit plan in
463	463	which the individual is enrolled.
464	464	SUBCHAPTER F. HEALTH SAVINGS ACCOUNTS
465	465	Sec. 537A.0251. ESTABLISHMENT AND OPERATION OF HEALTH
466	466	SAVINGS ACCOUNTS. (a) The commission shall establish a personal
467	467	wellness and responsibility account for each participant who is
468	468	enrolled in a program health benefit plan that is funded with money
469	469	contributed in accordance with this subchapter.
470	470	(b) The commission shall enable each participant to access
471	471	and manage money in and information regarding the participant's
472	472	Health Savings Account through an electronic system. The
473	473	commission may contract with an entity that has appropriate
474	474	experience and expertise to establish, implement, or administer the
475	475	electronic system.
476	476	(c) Except as otherwise provided by Section 537A.0252, the
477	477	commission shall require each participant to contribute to the
478	478	participant's Health Savings Account in amounts described by that
479	479	section.
480	480	Sec. 537A.0252. HEALTH SAVINGS ACCOUNT CONTRIBUTIONS;
481	481	DEDUCTIBLE. (a) The executive commissioner by rule shall
482	482	establish an annual universal deductible for each participant
483	483	enrolled in the basic or plus plan.
484	484	(b) To ensure each participant's Health Savings Account
485	485	contains a sufficient amount of money at the beginning of a coverage
486	486	period, the commission shall, before the beginning of that period,
487	487	fund each account with the following amounts:
488	488	(1) for a participant enrolled in the basic plan, the
489	489	annual universal deductible amount; and
490	490	(2) for a participant enrolled in the plus plan, the
491	491	difference between the annual universal deductible amount and the
492	492	participant's required annual contribution as determined by the
493	493	schedule established under Subsection (c).
494	494	(c) The executive commissioner by rule shall establish a
495	495	graduated annual Health Savings Account contribution schedule for
496	496	participants enrolled in the plus plan that:
497	497	(1) is based on a participant's annual household
498	498	income, with participants whose annual household incomes are less
499	499	than the federal poverty level paying progressively less and
500	500	participants whose annual household incomes are equal to or greater
501	501	than the federal poverty level paying progressively more; and
502	502	(2) may not require a participant to contribute more
503	503	than a total of five percent of the participant's annual household
504	504	income to the participant's Health Savings Account.
505	505	(d) A participant's employer may contribute on behalf of the
506	506	participant any amount of the participant's annual Health Savings
507	507	Account contribution. A nonprofit organization may contribute on
508	508	behalf of a participant any amount of the participant's annual
509	509	Health Savings Account contribution.
510	510	(e) Subject to the contribution cap described by Subsection
511	511	(c)(2) and not before the expiration of the participant's first
512	512	coverage period, the commission shall require a participant who
513	513	uses one or more tobacco products to contribute to the
514	514	participant's Health Savings Account an annual Health Savings
515	515	Account contribution amount that is one percent more than the
516	516	participant would otherwise be required to contribute under the
517	517	schedule established under Subsection (c).
518	518	(f) An annual Health Savings Account contribution must be
519	519	paid by or on behalf of a participant monthly in installments that
520	520	are at least equal to one-twelfth of the total required
521	521	contribution. The coverage period for a participant whose annual
522	522	household income exceeds 100 percent of the federal poverty level
523	523	may not begin until the first day of the first month following the
524	524	month in which the first monthly installment is received.
525	525	Sec. 537A.0253. USE OF HEALTH SAVINGS ACCOUNT MONEY. A
526	526	participant may use money in the participant's Health Savings
527	527	Account to pay copayments and deductible costs the participant's
528	528	program health benefit plan requires. The commission shall issue
529	529	to each participant an electronic payment card that allows the
530	530	participant to use the card to pay the program health benefit plan
531	531	costs.
532	532	Sec. 537A.0254. PROGRAM HEALTH BENEFIT PLAN PROVIDER
533	533	REWARDS PROGRAM FOR ENGAGEMENT IN CERTAIN HEALTHY BEHAVIORS;
534	534	SMOKING CESSATION INITIATIVE. (a) A program health benefit plan
535	535	provider shall establish a rewards program through which a
536	536	participant receiving health care through a program health benefit
537	537	plan the program health benefit plan provider offers may earn money
538	538	to be contributed to the participant's Health Savings Account.
539	539	(b) Under a rewards program, a program health benefit plan
540	540	provider shall contribute money to a participant's Health Savings
541	541	Account if the participant engages in certain healthy behaviors.
542	542	The executive commissioner by rule shall determine:
543	543	(1) the behaviors in which a participant must engage
544	544	to receive a contribution, which must include behaviors related to:
545	545	(A) completion of a health risk assessment;
546	546	(B) smoking cessation; and
547	547	(C) as applicable, chronic disease management;
548	548	and
549	549	(2) the amount of money a program health benefit plan
550	550	provider shall contribute for each behavior described by
551	551	Subdivision (1).
552	552	(c) Subsection (b) does not prevent a program health benefit
553	553	plan provider from contributing money to a participant's Health
554	554	Savings Account if the participant engages in a behavior not
555	555	specified by that subsection or a rule the executive commissioner
556	556	adopts in accordance with that subsection. If a program health
557	557	benefit plan provider chooses to contribute money under this
558	558	subsection, the program health benefit plan provider shall
559	559	determine the amount of money to be contributed for the behavior.
560	560	(d) A participant may use contributions a program health
561	561	benefit plan provider makes under a rewards program to offset a
562	562	maximum of 50 percent of the participant's required annual Health
563	563	Savings Account contribution the executive commissioner
564	564	establishes under Section 537A.0252.
565	565	(e) Contributions a program health benefit plan provider
566	566	makes under a rewards program that result in a participant's Health
567	567	Savings Account balance exceeding the participant's required
568	568	annual Health Savings Account contribution may be rolled over into
569	569	the next coverage period in accordance with Section 537A.0256.
570	570	(f) During the first coverage period of a participant who
571	571	uses one or more tobacco products, a program health benefit plan
572	572	provider shall actively attempt to engage the participant in and
573	573	provide educational materials to the participant on:
574	574	(1) smoking cessation activities for which the
575	575	participant may receive a monetary contribution under this section;
576	576	and
577	577	(2) other smoking cessation programs or resources
578	578	available to the participant.
579	579	Sec. 537A.0255. MONTHLY STATEMENTS. The commission shall
580	580	distribute to each participant with a Health Savings Account a
581	581	monthly statement that includes information on:
582	582	(1) the participant's Health Savings Account activity
583	583	during the preceding month, including information on the cost of
584	584	health care services delivered to the participant during that
585	585	month;
586	586	(2) the balance of money available in the Health
587	587	Savings Account at the time the statement is issued; and
588	588	(3) the amount of any contributions due from the
589	589	participant.
590	590	Sec. 537A.0256. HEALTH SAVINGS ACCOUNT ROLL OVER. (a) The
591	591	executive commissioner by rule shall establish a process in
592	592	accordance with this section to roll over money in a participant's
593	593	Health Savings Account to the succeeding coverage period. The
594	594	commission shall calculate the amount to be rolled over at the time
595	595	the participant's program eligibility is redetermined.
596	596	(b) For a participant enrolled in the basic plan, the
597	597	commission shall calculate the amount to be rolled over to a
598	598	subsequent coverage period Health Savings Account from the
599	599	participant's current coverage period Health Savings Account based
600	600	on:
601	601	(1) the amount of money remaining in the participant's
602	602	Health Savings Account from the current coverage period; and
603	603	(2) whether the participant received recommended
604	604	preventative care services during the current coverage period.
605	605	(c) For a participant enrolled in the plus plan who, as
606	606	determined by the commission, timely makes Health Savings Account
607	607	contributions in accordance with this subchapter, the commission
608	608	shall calculate the amount to be rolled over to a subsequent
609	609	coverage period Health Savings Account from the participant's
610	610	current coverage period Health Savings Account based on:
611	611	(1) the amount of money remaining in the participant's
612	612	Health Savings Account from the current coverage period;
613	613	(2) the total amount of money the participant
614	614	contributed to the participant's Health Savings Account during the
615	615	current coverage period; and
616	616	(3) whether the participant received recommended
617	617	preventative care services during the current coverage period.
618	618	(d) Except as provided by Subsection (e), a participant may
619	619	use money rolled over into the participant's Health Savings Account
620	620	for the succeeding coverage period to offset required annual Health
621	621	Savings Account contributions, as applicable, during that coverage
622	622	period.
623	623	(e) A participant enrolled in the basic plan who rolls over
624	624	money into the participant's Health Savings Account for the
625	625	succeeding coverage period and who chooses to enroll in the plus
626	626	plan for that coverage period may use the money rolled over to
627	627	offset a maximum of 50 percent of the required annual Health Savings
628	628	Account contributions for that coverage period.
629	629	Sec. 537A.0257. REFUND. If at the end of a participant's
630	630	coverage period the participant chooses to cease participating in a
631	631	program health benefit plan or is no longer eligible to participate
632	632	in a program health benefit plan, or if the commission disenrolls a
633	633	participant from the program health benefit plan under Section
634	634	537A.0258 for failure to pay required contributions, the commission
635	635	shall refund to the participant any money the participant
636	636	contributed that remains in the participant's Health Savings
637	637	Account at the end of the coverage period or on the disenrollment
638	638	date.
639	639	Sec. 537A.0258. PENALTIES FOR FAILURE TO MAKE HEALTH
640	640	SAVINGS ACCOUNT CONTRIBUTIONS. (a) For a participant whose annual
641	641	household income exceeds 100 percent of the federal poverty level
642	642	and who fails to make a contribution in accordance with Section
643	643	537A.0252, the commission shall provide a 60-day grace period
644	644	during which the participant may make the contribution without
645	645	penalty. If the participant fails to make the contribution during
646	646	the grace period, the commission shall disenroll the participant
647	647	from the program health benefit plan in which the participant is
648	648	enrolled and the participant may not reenroll in a program health
649	649	benefit plan until:
650	650	(1) the 181st day after the disenrollment date; and
651	651	(2) the participant pays any debt accrued due to the
652	652	participant's failure to make the contribution.
653	653	(b) For a participant enrolled in the plus plan whose annual
654	654	household income is equal to or less than 100 percent of the federal
655	655	poverty level and who fails to make a contribution in accordance
656	656	with Section 537A.0252, the commission shall disenroll the
657	657	participant from the plus plan and enroll the participant in the
658	658	basic plan. A participant enrolled in the basic plan under this
659	659	subsection may not change enrollment to the plus plan until the
660	660	participant's program eligibility is redetermined.
661	661	SUBCHAPTER G. EMPLOYMENT INITIATIVE
662	662	Sec. 537A.0301. GATEWAY TO WORK PROGRAM. (a) The
663	663	commission shall develop and implement a gateway to work program
664	664	to:
665	665	(1) integrate existing job training and job search
666	666	programs available in this state through the Texas Workforce
667	667	Commission or other appropriate state agencies with the Live Well
668	668	Texas program; and
669	669	(2) provide each participant with general information
670	670	on the job training and job search programs.
671	671	(b) Under the gateway to work program, the commission shall
672	672	refer each participant who is unemployed or working less than 20
673	673	hours a week to available job search and job training programs.
674	674	SUBCHAPTER H. HEALTH CARE FINANCIAL ASSISTANCE FOR CERTAIN
675	675	PARTICIPANTS
676	676	Sec. 537A.0351. HEALTH CARE FINANCIAL ASSISTANCE FOR
677	677	CONTINUITY OF CARE. (a) The commission shall ensure continuity of
678	678	care by providing health care financial assistance in accordance
679	679	with and in the manner described by this subchapter for a
680	680	participant who:
681	681	(1) the commission disenrolls from a program health
682	682	benefit plan in accordance with Section 537A.0155 because the
683	683	participant's annual household income exceeds the income
684	684	eligibility requirements for enrollment in a program health benefit
685	685	plan; and
686	686	(2) seeks and obtains private health benefit coverage
687	687	within 12 months following the date of disenrollment.
688	688	(b) To receive health care financial assistance under this
689	689	subchapter, a participant must provide to the commission, in the
690	690	form and manner the commission requires, documentation showing the
691	691	participant has obtained or is actively seeking private health
692	692	benefit coverage.
693	693	(c) The commission may not impose an upper income
694	694	eligibility limit on a participant to receive health care financial
695	695	assistance under this subchapter.
696	696	Sec. 537A.0352. DURATION AND AMOUNT OF HEALTH CARE
697	697	FINANCIAL ASSISTANCE. (a) A participant described by Section
698	698	537A.0351 may receive health care financial assistance under this
699	699	subchapter until the first anniversary of the date the commission
700	700	disenrolled the participant from a program health benefit plan.
701	701	(b) Health care financial assistance the commission makes
702	702	available to a participant under this subchapter:
703	703	(1) may not exceed the amount described by Section
704	704	537A.0353; and
705	705	(2) may be used only to pay for eligible services
706	706	described by Section 537A.0354.
707	707	Sec. 537A.0353. BRIDGE ACCOUNT; FUNDING. (a) The
708	708	commission shall establish a bridge account for each participant
709	709	eligible to receive health care financial assistance under Section
710	710	537A.0351. The account is funded with money the commission
711	711	contributes in accordance with this section.
712	712	(b) The commission shall enable each participant for whom
713	713	the commission establishes a bridge account to access and manage
714	714	money in and information regarding the participant's account
715	715	through an electronic system. The commission may contract with the
716	716	same entity described by Section 537A.0251(b) or another entity
717	717	with appropriate experience and expertise to establish, implement,
718	718	or administer the electronic system.
719	719	(c) The commission shall fund each bridge account in an
720	720	amount equal to $1,000 using money the commission retains or
721	721	recoups:
722	722	(1) during the roll over process described by Section
723	723	537A.0256;
724	724	(2) following the issuance of a refund as described by
725	725	Section 537A.0257; or
726	726	(3) under Subsection (e).
727	727	(d) The commission may not require a participant to
728	728	contribute money to the participant's bridge account.
729	729	(e) The commission shall retain or recoup any unexpended
730	730	money in a participant's bridge account at the end of the period for
731	731	which the participant is eligible to receive health care financial
732	732	assistance under this subchapter for the purpose of funding another
733	733	participant's Health Savings Account under Subchapter F or bridge
734	734	account under this subchapter.
735	735	Sec. 537A.0354. USE OF BRIDGE ACCOUNT MONEY. (a) The
736	736	commission shall issue to each participant for whom the commission
737	737	establishes a bridge account an electronic payment card that allows
738	738	the participant to use the card to pay costs for eligible services
739	739	described by Subsection (b).
740	740	(b) A participant may use money in the participant's bridge
741	741	account to pay:
742	742	(1) premium costs incurred during the private health
743	743	benefit coverage enrollment process and coverage period; and
744	744	(2) copayments, deductible costs, and coinsurance
745	745	associated with the private health benefit coverage the participant
746	746	obtains for health care services that would otherwise be
747	747	reimbursable under Medicaid.
748	748	(c) Costs described by Subsection (b)(2) associated with
749	749	eligible services delivered to a participant may be paid by:
750	750	(1) a participant using the electronic payment card
751	751	issued under Subsection (a); or
752	752	(2) a health care provider directly charging and
753	753	receiving payment from the participant's bridge account.
754	754	Sec. 537A.0355. ENROLLMENT COUNSELING. The commission
755	755	shall provide enrollment counseling to an individual who is seeking
756	756	private health benefit coverage and who is otherwise eligible to
757	757	receive health care financial assistance under this subchapter.
758	758	CHAPTER 537B. EXPANDED MEDICAID ELIGIBILITY FOR CERTAIN
759	759	INDIVIDUALS
760	760	Sec. 537B.0001. APPLICABILITY. This chapter applies only
761	761	to an individual who would be eligible to participate in the Live
762	762	Well Texas program under Chapter 537A based on the eligibility
763	763	requirements described by Section 537A.0151, if the commission were
764	764	to establish the program.
765	765	Sec. 537B.0002. EXPANDED MEDICAID ELIGIBILITY UNDER
766	766	PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a) Except as provided
767	767	by Subsection (b) and notwithstanding any other law, the commission
768	768	shall provide Medicaid benefits to all individuals who apply for
769	769	those benefits and to whom this chapter applies.
770	770	(b) After the waiver described by Section 537A.0051 is
771	771	approved and the commission implements the Live Well Texas program
772	772	under Chapter 537A, the commission shall:
773	773	(1) provide health benefit coverage through that
774	774	program in accordance with Chapter 537A to individuals to whom this
775	775	chapter applies; and
776	776	(2) cease providing Medicaid benefits to those
777	777	individuals, except as provided by Chapter 537A.
778	778	(c) The commission shall:
779	779	(1) continue to provide Medicaid benefits to
780	780	individuals described by Subsection (a) if the waiver described by
781	781	Section 537A.0051 is not approved; and
782	782	(2) resume providing Medicaid benefits to individuals
783	783	described by Subsection (a) if the Live Well Texas program
784	784	implemented under Chapter 537A terminates in accordance with
785	785	Section 537A.0053(b).
786	786	(d) The executive commissioner shall adopt rules regarding
787	787	the provision of Medicaid benefits as required by this section,
788	788	including, as applicable, rules on transitioning individuals from
789	789	receiving Medicaid benefits under this section to receiving health
790	790	benefit coverage under the Live Well Texas program implemented
791	791	under Chapter 537A.
792	792	SECTION 2. As soon as practicable after the effective date
793	793	of this Act, the executive commissioner of the Health and Human
794	794	Services Commission shall apply for and actively pursue from the
795	795	federal Centers for Medicare and Medicaid Services or another
796	796	appropriate federal agency the waiver as required by Section
797	797	537A.0051, Government Code, as added by this Act. The commission
798	798	may delay implementing other provisions of Chapter 537A, Government
799	799	Code, as added by this Act, until the waiver applied for under that
800	800	section is granted.
801	801	SECTION 3. (a) Chapter 537B, Government Code, as added by
802	802	this Act, applies only to an initial determination or
803	803	recertification of an individual's Medicaid eligibility under
804	804	Chapter 32, Human Resources Code, made on or after the
805	805	implementation of Chapter 537B, regardless of the date the
806	806	individual applied for Medicaid.
807	807	(b) As soon as practicable after the effective date of this
808	808	Act, the executive commissioner of the Health and Human Services
809	809	Commission shall take all necessary actions to expand Medicaid
810	810	eligibility in accordance with Chapter 537B, Government Code, as
811	811	added by this Act, including notifying appropriate federal agencies
812	812	of that expanded eligibility. If before implementing Chapter 537B
813	813	a state agency determines that any other waiver or authorization
814	814	from a federal agency is necessary for implementation of that
815	815	chapter, the agency affected by the chapter shall request the
816	816	waiver or authorization and may delay implementing that chapter
817	817	until the waiver or authorization is granted.
818	818	SECTION 4. This Act takes effect immediately if it receives
819	819	a vote of two-thirds of all the members elected to each house, as
820	820	provided by Section 39, Article III, Texas Constitution. If this
821	821	Act does not receive the vote necessary for immediate effect, this
822	822	Act takes effect September 1, 2025.