Bill Text: TX SB1477 | 2013-2014 | 83rd Legislature | Introduced
Bill Title: Relating to flexibility in the administration of the Medicaid program, a block grant funding approach to Medicaid expansion, and the establishment of a health benefit exchange tailored to the needs of the state.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2013-03-18 - Referred to Health & Human Services [SB1477 Detail]
Download: Texas-2013-SB1477-Introduced.html
By: Deuell | S.B. No. 1477 | |
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relating to flexibility in the administration of the Medicaid | ||
program, a block grant funding approach to Medicaid expansion, and | ||
the establishment of a health benefit exchange tailored to the | ||
needs of the state. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Section 531.02105 to read as follows: | ||
Sec. 531.02105. FLEXIBILITY FROM FEDERAL REQUIREMENTS. The | ||
commission shall negotiate with the United States secretary of | ||
health and human services, the federal Centers for Medicare and | ||
Medicaid Services, and other appropriate persons for flexibility to | ||
adjust the operation of the Medicaid program without the necessity | ||
of receiving federal approval for all changes to the program. Any | ||
agreement reached must identify broad categories of: | ||
(1) program changes that may be made without the need | ||
for additional federal approval; and | ||
(2) program changes that require additional federal | ||
approval. | ||
SECTION 2. Subtitle I, Title 4, Government Code, is amended | ||
by adding Chapter 539 to read as follows: | ||
CHAPTER 539. BLOCK GRANT PROGRAM FOR MEDICAID EXPANSION POPULATION | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 539.001. DEFINITIONS. In this chapter: | ||
(1) "Health benefit exchange" means an American Health | ||
Benefit Exchange administered by the federal government, an | ||
exchange created pursuant to Section 1311(b) of the Patient | ||
Protection and Affordable Care Act (42 U.S.C. Section 18031(b)), or | ||
a federally-authorized alternative state exchange. | ||
(2) "Medicaid expansion population" means the | ||
category of persons who would not be eligible for medical | ||
assistance under the eligibility criteria in effect on December 31, | ||
2013, but for whom federal matching funds are available under the | ||
Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as | ||
amended by the Health Care Affordable Care Act of 2010 (Pub. L. No. | ||
111-152) to provide that assistance. | ||
(3) "Medicaid program" means the medical assistance | ||
program established and operated under Title XIX of the federal | ||
Social Security Act (42 U.S.C. Section 1396 et seq.). | ||
(4) "State Medicaid program" means the medical | ||
assistance program operated by this state as part of the Medicaid | ||
program. | ||
Sec. 539.002. CONFLICT WITH OTHER LAW. To the extent of a | ||
conflict between a provision of this chapter and another state law, | ||
the provision of this chapter controls. | ||
SUBCHAPTER B. MEDICAID EXPANSION POPULATION PROGRAM REQUIREMENTS | ||
Sec. 539.051. FEDERAL AUTHORIZATION FOR BLOCK GRANT SYSTEM. | ||
The commission shall actively negotiate with the United States | ||
secretary of health and human services, the federal Centers for | ||
Medicare and Medicaid Services, and other appropriate persons for | ||
federal authorization for the state to operate the component of the | ||
state Medicaid program for providing program benefits to the | ||
Medicaid expansion population under a block grant funding system. | ||
Sec. 539.052. MINIMUM REQUIREMENTS OF FEDERAL | ||
AUTHORIZATION. (a) Federal authorization obtained under Section | ||
539.051 must allow for providing state Medicaid program benefits to | ||
recipients in the Medicaid expansion population in the form of | ||
premium assistance so private health benefit coverage may be | ||
obtained through a health benefit exchange. | ||
(b) The authorization negotiated as provided by Section | ||
539.051 must also allow for the provision of state Medicaid program | ||
benefits to recipients in the Medicaid expansion population in a | ||
manner that: | ||
(1) encourages the use of private health benefit | ||
coverage obtained through a health benefit exchange rather than | ||
public benefits systems by providing premium assistance; | ||
(2) creates customized health benefit plans for | ||
certain defined populations within the Medicaid expansion group; | ||
(3) encourages individuals who have access to private | ||
employer-based health benefit coverage to obtain or maintain that | ||
coverage; | ||
(4) includes cost-sharing provisions that require a | ||
recipient to be responsible for the payment of some premiums, | ||
copayments, and deductibles in amounts not to exceed five percent | ||
of a recipient's income; | ||
(5) establishes wellness initiatives; | ||
(6) encourages healthy lifestyles by adjusting | ||
copayments and deductibles based on certain health risk factors; | ||
(7) requires each recipient to undergo an annual | ||
physical examination with a primary care physician; | ||
(8) requires each recipient to lock into one primary | ||
care physician who will coordinate patient care, including the need | ||
for diagnostic testing, treatments, and referrals to specialists; | ||
(9) contains work requirements for recipients, with | ||
exceptions for recipients who are disabled, caretakers of disabled | ||
family members, or caretakers of young children who are not of | ||
school age; and | ||
(10) requires that health benefit plans for recipients | ||
to be issued on a guaranteed issue basis. | ||
Sec. 539.053. IMPLEMENTATION OF BLOCK GRANT SYSTEM. (a) If | ||
the commission receives the authorization described by Section | ||
539.052, the commission shall provide state Medicaid program | ||
benefits to all persons in the Medicaid expansion population who | ||
apply and are determined eligible for the assistance. | ||
(b) The commission shall: | ||
(1) provide state Medicaid program benefits to persons | ||
in the Medicaid expansion population in the manner allowed under | ||
the authorization; and | ||
(2) may not provide benefits to those persons under | ||
any fee-for-service or managed care delivery model or arrangement | ||
used to provide benefits to recipients who are not in the Medicaid | ||
expansion population. | ||
SUBCHAPTER C. FUNDING REDUCTIONS | ||
Sec. 539.101. APPROPRIATIONS REDUCTIONS. The commission | ||
shall ensure that legislative appropriations requests for the | ||
commission and health and human services agencies reflect | ||
reductions in the appropriated amounts needed to provide indigent | ||
health care services that result from the program implemented under | ||
this chapter. | ||
SECTION 3. The Health and Human Services Commission shall | ||
actively develop a proposal for the authorization from the | ||
appropriate federal entity as required by Chapter 539, Government | ||
Code, as added by this Act. 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. | ||
SECTION 4. (a) The Health and Human Services Commission, | ||
the Texas Department of Insurance, or the commission in conjunction | ||
with the department, shall negotiate with the appropriate federal | ||
entity for authorization to develop a state health benefit | ||
exchange. The negotiated authorization must allow the state health | ||
benefit exchange to be flexible, patient-friendly, tailored to the | ||
needs of the state, and be similar to the health benefit exchange | ||
described in the Patients' Choice Act, S.B. 516, 111th Congress | ||
(2009), or H.R. 2520, 111th Congress (2009). | ||
(b) If the appropriate federal entity authorizes a state | ||
health benefit exchange described in Subsection (a) of this | ||
section, the Health and Human Services Commission, the Texas | ||
Department of Insurance, or the commission in conjunction with the | ||
department, shall develop and implement the health benefit | ||
exchange. | ||
SECTION 5. This Act takes effect immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2013. |