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.