HBA-NMO H.B. 2558 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2558 By: Maxey Public Health 3/19/99 Introduced BACKGROUND AND PURPOSE The recommendations from 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. With the implementation of CHIP, certain children currently receiving benefits under the Chronically Ill and Disabled Children's Services Program (CIDC) would qualify for benefits under CHIP; however, certain others would not. If CHIP replaces CIDC, certain children may be left without health care benefits. H.B. 2558 changes the title of the Chronically Ill and Disabled Children's Services Program to the Services Program for Children With Special Health Care Needs (program), and requires the Texas Department of Health to develop and implement a health benefits plan under the program to provide coverage for children who are eligible for services under the program, but who are not eligible for assistance under CHIP or the medical assistance program under Chapter 32, Human Resources Code. This bill additionally requires the program to cover family support services and prohibits basing program eligibility on specific diseases or medical conditions, or assets available to a child. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Health in SECTION 14 of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 35.001, Health and Safety Code, to authorize that this chapter be cited as the Children with Special Health Care Needs Services Act, rather than the Chronically Ill and Disabled Children's Services Act. SECTION 2. Amends Section 35, Health and Safety Code, by adding Section 35.0021, as follows: Sec. 35.0021. DEFINITIONS. Defines "AIDS," "case management services," "child with special health care needs," "dentist," "facility," "family support services," "HIV," "other benefit," "physician," "program," "provider," "rehabilitation services," "services," "specialty center," and "support." SECTION 3. Amends Section 35.003, Health and Safety Code, as follows: Sec. 35.003. New title: SERVICES PROGRAM FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS. Deletes "chronically ill and disabled children's" from the title. Requires the program to provide family support services and access to health benefits plan coverage under Section 35.0031, in addition to certain other services. Deletes provision that requires the Texas Board of Health (board), by rule, to specify the diseases and conditions covered by the program. Authorizes the establishment of a waiting list of eligible persons, if necessary for the program to remain within the budgetary limitations. Makes conforming changes. SECTION 4. Amends Chapter 35, Health and Safety Code, by adding Sections 35.0031-35.0035, as follows: Sec. 35.0031. HEALTH BENEFITS PLAN COVERAGE FOR CERTAIN ELIGIBLE CHILDREN. Requires the Texas Department of Health (department) to develop and implement a health benefits plan (plan) to provide coverage for a child who is eligible for services under this chapter; and who is not eligible for assistance under a program established under Title XXI (State Children's Health Insurance Program or CHIP) of the Social Security Act, as amended, or the medical assistance program under Chapter 32 (Medical Assistance Program), Human Resources Code. Sec. 35.0032. BENEFITS COVERAGE REQUIRED. Provides that the plan, to the extent possible, must provide benefits comparable to the benefits provided under the state child health plan established by this state to implement Title XXI of the Social Security Act, as amended. Sec. 35.0033. HEALTH BENEFITS PLAN PROVIDER. Provides that a plan provider who provides coverage for benefits under Section 35.0031 must be certified by the Texas Department of Insurance and must satisfy the insurance law of this state. Provides that a health benefits provider under this chapter, except as required by the department, is not subject to a law that requires coverage or the offer of coverage of a health care service or benefit. Sec. 35.0034. COST-SHARING PAYMENTS. (a) Prohibits the department, except as provided by Subsection (b), from requiring a child who is provided plan coverage and who meets the income eligibility requirement of the medical assistance program under Chapter 32, Human Resources Code, to pay a premium, deductible, coinsurance, or other cost-sharing payment as a condition of plan coverage under this chapter. (b) Authorizes the department to require a child described by Subsection (a) to pay a copayment as a condition of plan coverage that is equal to any co-payment required under the state child health plan established by this state to implement CHIP. (c) Authorizes the department to require a child who is provided plan coverage and who meets the income eligibility requirement of a program established under CHIP to pay a premium, deductible, coinsurance, or other cost-sharing program as a condition of plan coverage. Provides that the payment must be equal to that required under CHIP. Sec. 35.0035. DISALLOWANCE OF MATCHING FUNDS FROM FEDERAL GOVERNMENT. Prohibits expenditures made to provide plan coverage from being included for the purposes of determining the state children's health insurance expenditures, as that term is defined in Title XXI of the Social Security Act, as amended. SECTION 5. Amends Section 35.004, Health and Safety Code, by adding Subsection (j), as follows: (j) Provides that this section (Service Providers) does not apply to services for which coverage is provided under the plan. SECTION 6. Amends Section 35.005, Health and Safety Code, to prohibit the board, in defining medical and financial criteria for eligibility, from establishing an exclusive list of coverable medical conditions, or consider as a source of support to provide services assets legally owned or available to a child's household. Makes conforming changes. SECTION 7. Amends Section 35.007, Health and Safety Code, to make conforming changes. SECTION 8. Amends Sections 35.012(a) and (b), Health and Safety Code, to make conforming changes. SECTION 9. Amends the heading of Chapter 35, Health and Safety Code, as follows: CHAPTER 35. CHILDREN WITH SPECIAL HEALTH CARE NEEDS SECTION 10. Amends Section 33.031, Health and Safety Code, to make conforming changes. SECTION 11. Amends Section 109.066, Health and Safety Code, to make conforming changes. SECTION 12. Amends Section 14(b)(2), Article 21.58A, Insurance Code, to make conforming changes. SECTION 13. Repealer: Section 35.002 (Definitions), Health and Safety Code. SECTION 14. Effective date: September 1, 1999. Makes application of this Act prospective to January 1, 2000. Requires the department to implement the plan not later than January 1, 2000. Requires the board to adopt all rules necessary to implement the changes in law made by this Act not later than January 1, 2000. SECTION 15. Emergency clause.