Bill Text: TX HB922 | 2021-2022 | 87th Legislature | Introduced


Bill Title: Relating to a "Texas Way" to reforming and addressing issues related to the Medicaid program, including the creation of an alternative program designed to ensure health benefit plan coverage to certain low-income individuals through the private marketplace.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2021-03-01 - Referred to Human Services [HB922 Detail]

Download: Texas-2021-HB922-Introduced.html
  87R3373 KFF-F
 
  By: Reynolds H.B. No. 922
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to a "Texas Way" to reforming and addressing issues
  related to the Medicaid program, including the creation of an
  alternative program designed to ensure health benefit plan coverage
  to certain low-income individuals through the private marketplace.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
  ARTICLE 1.  BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
         SECTION 1.01.  Subtitle I, Title 4, Government Code, is
  amended by adding Chapter 540 to read as follows:
  CHAPTER 540.  BLOCK GRANT FUNDING SYSTEM FOR STATE MEDICAID PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 540.0001.  DEFINITIONS. Notwithstanding Section
  531.001, in this chapter:
               (1)  "Health benefit exchange" means an American Health
  Benefit Exchange administered by the federal government or an
  exchange created under Section 1311(b) of the Patient Protection
  and Affordable Care Act (42 U.S.C. Section 18031(b)).
               (2)  "Medicaid program" means the medical assistance
  program established and operated under Title XIX, Social Security
  Act (42 U.S.C. Section 1396 et seq.).
               (3)  "State Medicaid program" means the medical
  assistance program provided by this state under the Medicaid
  program.
         Sec. 540.0002.  FEDERAL AUTHORIZATION TO REFORM MEDICAID
  REQUIRED. If the federal government establishes, through
  conversion or otherwise, a block grant funding system for the
  Medicaid program or otherwise authorizes the state Medicaid program
  to operate under a block grant funding system, including under a
  Medicaid program waiver, the commission, in cooperation with
  applicable health and human services agencies, shall, subject to
  Section 540.0003, administer and operate the state Medicaid program
  in accordance with this chapter.
         Sec. 540.0003.  CONFLICT WITH OTHER LAW. To the extent of a
  conflict between a provision of this chapter and:
               (1)  another provision of state law, the provision of
  this chapter controls, subject to Section 540A.0002(b); and
               (2)  a provision of federal law or any authorization
  described under Section 540.0002, the federal law or authorization
  controls.
         Sec. 540.0004.  ESTABLISHMENT OF REFORMED STATE MEDICAID
  PROGRAM. The commission shall establish a state Medicaid program
  that provides benefits under a risk-based Medicaid managed care
  model.
         Sec. 540.0005.  RULES. The executive commissioner shall
  adopt rules necessary to implement this chapter.
  SUBCHAPTER B.  ACUTE CARE
         Sec. 540.0051.  ELIGIBILITY FOR MEDICAID ACUTE CARE. (a)  An
  individual is eligible to receive acute care benefits under the
  state Medicaid program if the individual:
               (1)  has a household income at or below 100 percent of
  the federal poverty level;
               (2)  is under 19 years of age and:
                     (A)  is receiving Supplemental Security Income
  (SSI) under 42 U.S.C. Section 1381 et seq.; or
                     (B)  is in foster care or resides in another
  residential care setting under the conservatorship of the
  Department of Family and Protective Services; or
               (3)  meets the eligibility requirements that were in
  effect in this state on August 31, 2021.
         (b)  The commission shall provide acute care benefits under
  the state Medicaid program to each individual eligible under this
  section through the most cost-effective means, as determined by the
  commission.
         (c)  If an individual is not eligible for the state Medicaid
  program under Subsection (a), the commission shall refer the
  individual to the program established under Chapter 540A that helps
  connect eligible residents with health benefit plan coverage
  through private market solutions, a health benefit exchange, or any
  other resource the commission determines appropriate.
         Sec. 540.0052.  MEDICAID SLIDING SCALE SUBSIDIES. (a)  An
  individual who is eligible for the state Medicaid program under
  Section 540.0051 may receive a Medicaid sliding scale subsidy to
  purchase a health benefit plan from an authorized health benefit
  plan issuer.
         (b)  A sliding scale subsidy provided to an individual under
  this section must:
               (1)  be based on:
                     (A)  the average premium in the market; and
                     (B) a realistic assessment of the individual's
  ability to pay a portion of the premium; and
               (2)  include an enhancement for individuals who choose
  a high deductible health plan with a health savings account.
         (c)  The commission shall ensure that counselors are made
  available to individuals receiving a subsidy to advise the
  individuals on selecting a health benefit plan that meets the
  individuals' needs.
         (d)  An individual receiving a subsidy under this section is
  responsible for paying:
               (1)  any difference between the premium costs
  associated with the purchase of a health benefit plan and the amount
  of the individual's subsidy under this section; and
               (2)  any copayments associated with the health benefit
  plan, except to the extent the individual receives an additional
  subsidy under Section 540.0053 to pay the copayments.
         (e)  If the amount of a subsidy received by an individual
  under this section exceeds the premium costs associated with the
  individual's purchase of a health benefit plan, the individual may
  deposit the excess amount in a health savings account that may be
  used only in the manner described by Section 540.0054(b).
         Sec. 540.0053.  ADDITIONAL COST-SHARING SUBSIDIES. In
  addition to providing a subsidy to an individual under Section
  540.0052, the commission shall provide additional subsidies for
  coinsurance payments, copayments, deductibles, and other
  cost-sharing requirements associated with the individual's health
  benefit plan.  The commission shall provide the additional
  subsidies on a sliding scale based on income.
         Sec. 540.0054.  DELIVERY OF SUBSIDIES; HEALTH SAVINGS
  ACCOUNTS.  (a)  The commission shall determine the most appropriate
  manner for delivering and administering subsidies provided under
  Sections 540.0052 and 540.0053. In determining the most
  appropriate manner, the commission shall consider depositing
  subsidy amounts for an individual in a health savings account
  established for that individual.
         (b)  A health savings account established under this section
  may be used only to:
               (1)  pay health benefit plan premiums and cost-sharing
  amounts; and
               (2)  if appropriate, purchase health care-related
  goods and services.
         Sec. 540.0055.  MEDICAID HEALTH BENEFIT PLAN ISSUERS AND
  MINIMUM COVERAGE. The commission shall allow any health benefit
  plan issuer authorized to write health benefit plans in this state
  to participate in the state Medicaid program.  The commission in
  consultation with the commissioner of insurance shall establish
  minimum coverage requirements for a health benefit plan to be
  eligible for purchase under the state Medicaid program, subject to
  the requirements specified by this chapter.
         Sec. 540.0056.  REINSURANCE FOR PARTICIPATING HEALTH
  BENEFIT PLAN ISSUERS.  (a)  The commission in consultation with the
  commissioner of insurance shall study a reinsurance program to
  reinsure participating health benefit plan issuers.
         (b)  In examining options for a reinsurance program, the
  commission and the commissioner of insurance shall consider a plan
  design under which:
               (1)  a participating health benefit plan is not charged
  a premium for the reinsurance; and
               (2)  the health benefit plan issuer retains risk on a
  sliding scale.
  SUBCHAPTER C. LONG-TERM SERVICES AND SUPPORTS
         Sec. 540.0101.  PLAN TO REFORM DELIVERY OF LONG-TERM
  SERVICES AND SUPPORTS.  The commission shall develop a
  comprehensive plan to reform the delivery of long-term services and
  supports that is designed to achieve the following objectives under
  the state Medicaid program or any other program created as an
  alternative to the state Medicaid program:
               (1)  encourage consumer direction;
               (2)  simplify and streamline the provision of services;
               (3)  provide flexibility to design benefits packages
  that meet the needs of individuals receiving long-term services and
  supports under the program;
               (4)  improve the cost-effectiveness and sustainability
  of the provision of long-term services and supports;
               (5)  reduce reliance on institutional settings; and
               (6)  encourage cost-sharing by family members when
  appropriate.
  ARTICLE 2.  PROGRAM TO ENSURE HEALTH BENEFIT COVERAGE FOR CERTAIN
  INDIVIDUALS THROUGH PRIVATE MARKETPLACE
         SECTION 2.01.  Subtitle I, Title 4, Government Code, is
  amended by adding Chapter 540A to read as follows:
  CHAPTER 540A.  PROGRAM TO ENSURE HEALTH BENEFIT PLAN COVERAGE FOR
  CERTAIN INDIVIDUALS THROUGH PRIVATE MARKET SOLUTIONS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 540A.0001.  DEFINITION. In this chapter, "state
  Medicaid program" has the meaning assigned by Section 540.0001.
         Sec. 540A.0002.  CONFLICT WITH OTHER LAW. (a)  Except as
  provided by Subsection (b), to the extent of a conflict between a
  provision of this chapter and:
               (1)  another provision of state law, the provision of
  this chapter controls; and
               (2)  a provision of federal law or any authorization
  described under Subchapter B, the federal law or authorization
  controls.
         (b)  The program operated under this chapter is in addition
  to the state Medicaid program operated under Chapter 32, Human
  Resources Code, or under a block grant funding system under Chapter
  540.
         Sec. 540A.0003.  PROGRAM FOR HEALTH BENEFIT PLAN COVERAGE
  THROUGH PRIVATE MARKET SOLUTIONS. Subject to the requirements of
  this chapter, the commission in consultation with the commissioner
  of insurance shall develop and implement a program that helps
  connect certain low-income residents of this state with health
  benefit plan coverage through private market solutions.
         Sec. 540A.0004.  NOT AN ENTITLEMENT. This chapter does not
  establish an entitlement to assistance in obtaining health benefit
  plan coverage.
         Sec. 540A.0005.  RULES. The executive commissioner shall
  adopt rules necessary to implement this chapter.
  SUBCHAPTER B.  FEDERAL AUTHORIZATION
         Sec. 540A.0051.  FEDERAL AUTHORIZATION FOR FLEXIBILITY TO
  ESTABLISH PROGRAM. (a)  The commission in consultation with the
  commissioner of insurance shall negotiate with the United States
  secretary of health and human services, the Centers for Medicare
  and Medicaid Services, and other appropriate persons for purposes
  of seeking a waiver or other authorization necessary to obtain the
  flexibility to use federal matching funds to help provide, in
  accordance with Subchapter C, health benefit plan coverage to
  certain low-income individuals through private market solutions.
         (b)  Any agreement reached under this section must:
               (1)  create a program that is made cost neutral to this
  state by:
                     (A)  leveraging premium tax revenues; and
                     (B)  achieving cost savings through offsets to
  general revenue health care costs or the implementation of other
  cost savings mechanisms;
               (2)  create more efficient health benefit plan coverage
  options for eligible individuals through:
                     (A)  program changes that may be made without the
  need for additional federal approval; and
                     (B)  program changes that require additional
  federal approval;
               (3)  require the commission to achieve efficiency and
  reduce unnecessary utilization, including duplication, of health
  care services;
               (4)  be designed with the goals of:
                     (A)  relieving local tax burdens;
                     (B)  reducing general revenue reliance so as to
  make general revenue available for other state priorities; and
                     (C)  minimizing the impact of any federal health
  care laws on Texas-based businesses; and
               (5)  afford this state the opportunity to develop a
  state-specific way with benefits that specifically meet the unique
  needs of this state's population.
         (c)  An agreement reached under this section may be:
               (1)  limited in duration; and
               (2)  contingent on continued funding by the federal
  government.
  SUBCHAPTER C.  PROGRAM REQUIREMENTS
         Sec. 540A.0101.  ENROLLMENT ELIGIBILITY. (a)  Subject to
  Subsection (b), an individual may be eligible to enroll in a program
  designed and established under this chapter if the person:
               (1)  is younger than 65;
               (2)  has a household income at or below 133 percent of
  the federal poverty level; and
               (3)  is not otherwise eligible to receive benefits
  under the state Medicaid program, including through a program
  operated under Chapter 32, Human Resources Code, or under Chapter
  540 through a block grant funding system or a waiver, other than a
  waiver granted under this chapter, to the program.
         (b)  The executive commissioner may modify or further define
  the eligibility requirements of this section if the commission
  determines it necessary to reach an agreement under Subchapter B.
         Sec. 540A.0102.  MINIMUM PROGRAM REQUIREMENTS. A program
  designed and established under this chapter must:
               (1)  if cost-effective for this state, provide premium
  assistance to purchase health benefit plan coverage in the private
  market, including health benefit plan coverage offered through a
  managed care delivery model;
               (2)  provide enrollees with access to health benefits,
  including benefits provided through a managed care delivery model,
  that:
                     (A)  are tailored to the enrollees;
                     (B)  provide levels of coverage that are
  customized to meet health care needs of individuals within defined
  categories of the enrolled population; and
                     (C)  emphasize personal responsibility and
  accountability through flexible and meaningful cost-sharing
  requirements and wellness initiatives, including through
  incentives for compliance with health, wellness, and treatment
  strategies and disincentives for noncompliance;
               (3)  include pay-for-performance initiatives for
  private health benefit plan issuers that participate in the
  program;
               (4)  use technology to maximize the efficiency with
  which the commission and any health benefit plan issuer, health
  care provider, or managed care organization participating in the
  program manage enrollee participation;
               (5)  allow recipients under the state Medicaid program
  to enroll in the program to receive premium assistance as an
  alternative to the state Medicaid program;
               (6)  encourage eligible individuals to enroll in other
  private or employer-sponsored health benefit plan coverage, if
  available and appropriate;
               (7)  encourage the utilization of health care services
  in the most appropriate low-cost settings; and
               (8)  establish health savings accounts for enrollees,
  as appropriate.
         SECTION 2.02.  The Health and Human Services Commission in
  consultation with the commissioner of insurance shall actively
  develop a proposal for the authorization from the appropriate
  federal entity as required by Subchapter B, Chapter 540A,
  Government Code, as added by this article. As soon as possible
  after the effective date of this Act, the Health and Human Services
  Commission shall request and actively pursue obtaining the
  authorization from the appropriate federal entity.
  ARTICLE 3.  FEDERAL AUTHORIZATION AND EFFECTIVE DATE
         SECTION 3.01.  Subject to Section 2.02 of this Act, if before
  implementing any provision of this Act a state agency determines
  that a waiver or authorization from a federal agency is necessary
  for implementation of that provision, the agency affected by the
  provision shall request the waiver or authorization and may delay
  implementing that provision until the waiver or authorization is
  granted.
         SECTION 3.02.  This Act takes effect September 1, 2021.
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