HBA-NMO S.B. 445 76(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 445 By: Moncrief Public Health 3/29/1999 Engrossed BACKGROUND AND PURPOSE Currently, the largest group of the estimated 1.4 million children in this state that do not have health insurance coverage are those children from low-income working families. Many of these children are not eligible for Medicaid or other public programs, and their parents may not have access to employer-based coverage. In an effort to increase the number of children with health insurance coverage, Congress has provided $48 billion over the next ten years through the Balanced Budget Act of 1997, under Title XXI of the Social Security Act, for the development of states' children's health insurance programs. In consideration of this provision, the recommendations of the Interim House Committee on Public Health include the implementation of Phase II of a state-designed Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act. S.B. 445 requires the Health and Human Services Commission (HHSC) to develop a state-designed CHIP to obtain health benefits coverage for children in low income families. This bill also requires HHSC to ensure that CHIP is designed and administered in a manner that qualifies it for federal funding, and provides that CHIP does not establish an entitlement and terminates at the time that federal funding terminates. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Health and Human Services Commission in SECTION 1 (Sections 62.051(c), 62.052(b), 62.053(c), and 62.102, Health and Safety Code); to the Texas Department of Health in SECTION 1 (Section 62.052(b), Health and Safety Code); to the Texas Department of Human Services in SECTION 1 (Section 62.053(c), Health and Safety Code); and to the Texas Department of Insurance in SECTION 1 (Section 62.054(c), Health and Safety Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Title 2C, Health and Safety Code, by adding Chapter 62, as follows: CHAPTER 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN SUBCHAPTER A. GENERAL PROVISIONS Sec. 62.001. DEFINITION. Defines "commission" as the Health and Human Services Commission and "commissioner" as the commissioner of health and human services. Sec. 62.002. NOT AN ENTITLEMENT; TERMINATION OF PROGRAM. Provides that this chapter does not establish an entitlement to assistance in obtaining health benefits for a child. Provides that the program established under this chapter terminates at the time that federal funding terminates under Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended, or another law providing federal funding for a state-designed child health plan. SUBCHAPTER B. ADMINISTRATION OF CHILD HEALTH PLAN PROGRAM Sec. 62.051. DUTIES OF COMMISSION. Requires the Health and Human Services Commission (HHSC) to develop a state-designed child health plan program (program) to obtain health benefits coverage for children in low-income families. Requires HHSC to ensure that the program is designed and administered in a manner that qualifies it for federal funding. Requires HHSC to oversee the implementation of the program and coordinate the activities of each agency necessary for the implementation of the program. Authorizes HHSC to adopt rules as necessary to implement this chapter. Authorizes HHSC to require certain departments or any other health and human services agency to adopt, with the approval of HHSC, any rules that may be adopted under this subsection. Authorizes HHSC to delegate to certain agencies the authority to adopt any rules that may be adopted under this subsection. Sec. 62.052. DUTIES OF TEXAS DEPARTMENT OF HEALTH. Requires the Texas Department of Health (TDH) to administer the child health plan (plan) under the direction of HHSC. Sets forth requirements of TDH. Authorizes HHSC, or TDH under the direction of and consultation with HHSC, to adopt rules as necessary to implement this section. Sec. 62.053. DUTIES OF TEXAS DEPARTMENT OF HUMAN SERVICES. Requires the Texas Department of Human Services (DHS) to perform certain tasks, under the direction of HHSC. Requires DHS, under the direction of HHSC, to perform certain tasks if HHSC contracts with a third party administrator. Authorizes HHSC, or DHS under direction of and consultation with HHSC, to adopt rules as necessary to implement this section. Sec. 62.054. DUTIES OF TEXAS DEPARTMENT OF INSURANCE. Requires the Texas Department of Insurance (TDI) to provide any necessary assistance with the development of the plan, at the request of HHSC. Requires TDI to monitor the quality of the services provided by health benefit plan providers and resolve grievances relating to the providers. Authorizes HHSC and TDI to adopt a memorandum of understanding that addresses the responsibilities of each agency in developing the plan. Authorizes TDI, in consultation with HHSC, to adopt rules as necessary to implement this section. Sec. 62.055. CONTRACTS FOR IMPLEMENTATION OF CHILD HEALTH PLAN. Authorizes HHSC to contract with certain entities in administering the plan. Authorizes a third party administrator or other entity to perform tasks under the contract that would otherwise be performed by TDH to DHS under this chapter. Authorizes HHSC to require TDH or DHS, as HHSC determines appropriate, to take certain action, if HHSC enters into a contract with an entity, including the Texas Healthy Kids Corporation, to obtain health benefit plan coverage for children who are eligible for coverage under the plan. Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE. Requires HHSC to conduct a community outreach and education campaign (campaign) to provide information relating to the availability of health benefits for children. Requires HHSC to conduct the campaign in coordination with the Texas Healthy Kids Corporation in a manner that promotes the goals of both programs and minimizes duplication of effort. Provides that the campaign must include a toll-free telephone number through which families may obtain information about health benefits coverage for children. Provides that HHSC must provide grants to community-based organizations to implement the campaign. Authorizes HHSC to direct TDH or DHS to perform all or part of the outreach campaign. SUBCHAPTER C. ELIGIBILITY FOR COVERAGE UNDER CHILD HEALTH PLAN Sec. 62.101. ELIGIBILITY. (a) Provides that a child is eligible for health benefits coverage under the plan if the child is younger than 19 years of age; is not eligible for medical assistance under the Medicaid program; is not covered by a health benefits plan offering adequate benefits, as determined by HHSC; has a family income that is less than or equal to the income eligibility level established under Subsection (b); and satisfies any other eligibility standard imposed under the child health plan program in accordance with 42 U.S.C. Section 1397bb, as amended, and any other applicable law or regulations. (b) Requires HHSC to establish an income eligibility level consistent with Title XXI of the Social Security Act and any other applicable law or regulations, subject to the availability of appropriated money. Requires that children ages birth through 10 years whose net family income is at or below 200 percent of the federal poverty at the implementation of the program level be eligible for health benefits coverage. Requires that children ages 11 through 18 years of age whose net family income is at or below 150 percent of the federal poverty level also be eligible. Defines "net family income." (c) Requires the commissioner of health and human services (commissioner) to evaluate enrollment levels and program impact every six months during the first 12 months of implementation and at least annually thereafter and to submit a finding of fact to the Legislative Budget Board and the Governor's Office of Budget and Planning as to the adequacy of funding and the ability of the program to sustain enrollment at higher income eligibility levels for children ages 11 through 18 years of age. Requires the commissioner to adjust the income limits to a higher level after submittal of a finding of fact that funding for the child health plan is sufficient to support and sustain enrollment at the higher level. (d) Requires the commissioner, prior to implementation of the program and on an annual basis thereafter, to evaluate enrollment levels and program impact and submit a finding of fact to the Legislative Budget Board and the Governor's Office of Budget and Planning as to the adequacy of funding and the ability of the program to sustain enrollment of children ages 8 through 10 whose family income is between 150 percent and 200 percent of the federal poverty level. Requires the commissioner to adjust the income limit to a lower level after submittal of a finding of fact that funding for the child health plan is not sufficient to sustain enrollment at the higher level. Prohibits an adjustment to an income limit made under this subsection from removing health insurance coverage from a child already insured under this chapter. Sec. 62.102. CONTINUOUS COVERAGE. Authorizes HHSC, by rule, to provide that an individual who is determined to be eligible for coverage under the child health plan remains eligible for those benefits until a certain time. Sec. 62.103. APPLICATION FORM AND PROCEDURES. Requires HHSC, or DHS at the direction of and in consultation with HHSC, to adopt an application form and application procedures for requesting plan coverage under this chapter. Provides that the form and procedures be coordinated with forms and procedures under the Medicaid program and forms and procedures used by the Texas Healthy Kids Corporation so that a person is able to submit a single consolidated application to seek assistance under this chapter or the Medicaid program or from the corporation. Authorizes HHSC to permit application to be made by mail, over the telephone, or through the Internet. Sec. 62.104. ELIGIBILITY SCREENING AND ENROLLMENT. Requires HHSC, or DHS at the direction and in consultation with HHSC, to develop eligibility screening and enrollment procedures for children that comply with the requirements of 42 U.S.C. Section 1397bb, as amended, and any other applicable law or regulations. Requires that the procedures ensure that Medicaid-eligible children are identified and referred to the Medicaid program. Authorizes the Texas Integrated Enrollment Services eligibility determination system or a compatible system to be used to screen and enroll children under the plan. SUBCHAPTER D. CHILD HEALTH PLAN Sec. 62.151. CHILD HEALTH PLAN COVER-AGE. Requires that the plan comply with this chapter and the coverage requirements prescribed by 42 U.S.C. Section 1397cc, as amended, and any other applicable law or regulations. Requires HHSC to consider the health care needs of certain children. Requires HHSC to consider the health benefit plans providing coverage to state employees under the Texas Employees Uniform Group Insurance Benefits Act and authorizes it to use a health benefit plan providing coverage under that article as a model for the plan. Authorizes that the benefits offered under the child health plan vary from the benefits offered state employees. Provides that the plan must allow an enrolled child with a chronic, disabling, or life-threatening illness to select an appropriate specialist as a primary care physician. Sec. 62.152. APPLICATION OF INSURANCE LAW. Provides that, to provide the flexibility necessary to satisfy the requirements of Title XXI of the Social Security Act, as amended, and any other applicable law or regulations, the plan is not subject to a law that requires certain coverage. Sec. 62.153. COST SHARING. Authorizes HHSC to require enrollees to share the cost of the plan, including provisions requiring enrollees to pay certain costs. Requires cost-sharing provisions adopted under this section to ensure that families with higher levels of income are required to pay progressively higher percentages of the cost of the plan. Requires HHSC to specify the manner in which the premiums are to be paid, if cost-sharing provisions imposed under Subsection (a) include requirements that enrollees pay a portion of the plan premium. Authorizes HHSC to require that the premium be paid to TDH, DHS, or the child health plan provider. Sec. 62.154. CROWD OUT. Provides that, to the extent permitted under Title XXI of the Social Security Act, as amended, and any other applicable law or regulations, the plan may include waiting periods, copayments, and other provisions to discourage certain acts. Sec. 62.155. CHILD HEALTH PLAN PROVIDERS. Requires HHSC or TDH, at the direction of and in consultation with HHSC, to select the plan providers under the program through open enrollment or a competitive bid process. Provides that a plan provider must meet certain requirements. SUBCHAPTER E. LEGISLATIVE OVERSIGHT Sec. 62.201. DEFINITION. Defines "committee" as the child health plan legislative oversight committee. Sec. 62.202. COMPOSITION OF COMMITTEE; PRESIDING OFFICER. Sets forth the composition of the committee. Provides that a member of the committee serves at the pleasure of the appointing official. Requires the lieutenant governor and the speaker of the house of representatives to appoint the presiding officer of the committee on an alternating basis. Provides that the officer serves a two-year term expiring August 31 of each oddnumbered year. Sec. 62.203. COMMITTEE POWERS AND DUTIES. Sets forth requirements for the committee. Authorizes the committee to issue process, in accordance with Section 301.024 (Process), Government Code, to compel the attendance of witnesses and the production of books, records, documents, and instruments required by the committee. Requires the committee to monitor the effectiveness and efficiency of the program under this chapter. Requires HHSC and TDH to report quarterly to the committee on implementation and administration of the program and the use of money appropriated for the program. Authorizes the committee to request additional reports and other information relating to the program from HHSC and certain agencies. Requires the committee to use the existing staff resources of the senate and the house of representatives to assist the committee in performing its duties. Sec. 62.204. REPORT. Requires the committee to report to the governor, lieutenant governor, and speaker of the house of representatives not later November 15 of each evennumbered year. Sets forth the requirements of the report. Sec. 62.205. RIGHTS OF EMPLOYEES; RETALIATION PROHIBITED. Defines "personnel action." Authorizes an employee of any agency necessary to the implementation of the program to cooperate with the committee in the performance of its functions. Prohibits the agency from suspending or terminating the employment of, or taking another adverse personnel action against, an employee of the agency solely because the employee cooperates with the committee on good faith. Sec. 62.206. EXPIRATION. Provides that the committee is abolished and this subchapter expires September 1, 2003. SECTION 2. Amends Chapter 109, Health and Safety Code, by adding Subchapter F, as follows: SUBCHAPTER F. STATE CHILD HEALTH PLAN Sec. 109.201. DEFINITIONS. Defines "commission" and "state child health plan." Sec. 109.202. CHILD HEALTH PLAN COVERAGE. Authorizes HHSC to use appropriated funds, in accordance with the General Appropriations Act, to purchase coverage under the plan and to contract with the Texas Healthy Kids Corporation (corporation) for other services under this subchapter. Provides that the plan coverage offered under this subchapter must be approved by HHSC. Requires HHSC to ensure that coverage provided under this subchapter complies with Chapter 62. Sec. 109.203. ELIGIBILITY. Provides that an individual who is eligible for coverage under the plan, as determined by HHSC, notwithstanding any other provision of this chapter or the eligibility criteria established under Section 109.061 (Health Benefit Program), Health and Safety Code, is eligible for coverage provided through the corporation under this subchapter. Sec. 109.204. COMMUNITY OUTREACH; ELIGIBILITY SCREENING. Authorizes the corporation, under direction of HHSC, in connection with offering a plan under this subchapter, to take certain action. Provides that the eligibility screening and enrollment procedures used by the corporation comply with Chapter 62. Sec. 109.205. REPORTING AND ACCOUNTABILITY. Requires the corporation to report to HHSC as required by HHSC or the agency designated under Section 62.055 with respect to coverage and services under this subchapter. Requires HHSC or the agency designated under Section 62.055 to establish a procedure to monitor the provision of coverage and services under this subchapter. SECTION 3. Amends Section 4, Article 3.51-6, Insurance Code, as follows: Sec. 4. New Title: EXEMPTIONS. Makes conforming changes and those relating to recodification. SECTION 4. Requires HHSC, by September 1, 1999, to develop the plan and submit for approval a plan amendment relating to the child health plan under 42 U.S.C. Section 1397ff, as amended. SECTION 5. Requires HHSC, if before implementing any provision of Chapter 62 it determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, to request the waiver or authorization and authorizes it to delay implementing that provision until the waiver or authorization is granted. SECTION 6.Emergency clause. Effective date: upon passage.