HB2627 - Relating to the development and implementation of the Live Well Texas program and the expansion of Medicaid eligibility to provide health benefit coverage to certain individuals; imposing penalties.

  89R1026 JG-D     By: Garcia Hernandez H.B. No. 2627       A BILL TO BE ENTITLED   AN ACT   relating to the development and implementation of the Live Well   Texas program and the expansion of Medicaid eligibility to provide   health benefit coverage to certain individuals; imposing   penalties.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle I, Title 4, Government Code, is amended   by adding Chapters 532A and 532B to read as follows:   CHAPTER 532A. LIVE WELL TEXAS PROGRAM   SUBCHAPTER A. GENERAL PROVISIONS           Sec. 532A.0001.  DEFINITIONS. In this chapter:                 (1)     "Basic plan" means the program health benefit plan   described by Section 532A.0202.                 (2)     "Eligible individual" means an individual who is   eligible to participate in the program.                 (3)  "Participant" means an individual who is:                       (A)  enrolled in a program health benefit plan; or                       (B)     receiving health care financial assistance   under Subchapter H.                 (4)     "Plus plan" means the program health benefit plan   described by Section 532A.0203.                 (5)     "POWER account" means a personal wellness and   responsibility account the commission establishes for a   participant under Section 532A.0251.                 (6)     "Program" means the Live Well Texas program   established under this chapter.                 (7)  "Program health benefit plan" includes:                       (A)  the basic plan; and                       (B)  the plus plan.                 (8)     "Program health benefit plan provider" means a   health benefit plan provider that contracts with the commission   under Section 532A.0107 to arrange for the provision of health care   services through a program health benefit plan.   SUBCHAPTER B. FEDERAL WAIVER FOR LIVE WELL TEXAS PROGRAM           Sec.   532A.0051.     FEDERAL AUTHORIZATION FOR PROGRAM. (a)   Notwithstanding any other law, the executive commissioner shall   develop and seek a waiver under Section 1115 of the Social Security   Act (42 U.S.C. Section 1315) to the state Medicaid plan to implement   the Live Well Texas program to assist individuals in obtaining   health benefit coverage through a program health benefit plan or   health care financial assistance.           (b)     The terms of a waiver the executive commissioner seeks   under this section must:                 (1)  be designed to:                       (A)     provide health benefit coverage options for   eligible individuals;                       (B)     produce better health outcomes for   participants;                       (C)     create incentives for participants to   transition from receiving public assistance benefits to achieving   stable employment;                       (D)     promote personal responsibility and engage   participants in making decisions regarding health care based on   cost and quality;                       (E)     support participants' self-sufficiency by   requiring unemployed participants to be referred to work search and   job training programs;                       (F)     support participants who become ineligible   to participate in a program health benefit plan in transitioning to   private health benefit coverage; and                       (G)     leverage enhanced federal medical assistance   percentage funding to minimize or eliminate the need for a program   enrollment cap; and                 (2)     allow for the operation of the program consistent   with the requirements of this chapter, except to the extent   deviation from the requirements is necessary to obtain federal   authorization of the waiver.           Sec.   532A.0052.     FUNDING. Subject to approval of the waiver   described by Section 532A.0051, the commission shall implement the   program using enhanced federal medical assistance percentage   funding available under the Patient Protection and Affordable Care   Act (Pub. L. No.   111-148) as amended by the Health Care and   Education Reconciliation Act of 2010 (Pub. L. No.   111-152).           Sec.   532A.0053.     NOT AN ENTITLEMENT; TERMINATION OF PROGRAM.   (a) This chapter does not establish an entitlement to health   benefit coverage or health care financial assistance under the   program for eligible individuals.           (b)     The program terminates at the time the share of federal   funding for the program under the Patient Protection and Affordable   Care Act (Pub. L. No.   111-148) as amended by the Health Care and   Education Reconciliation Act of 2010 (Pub. L. No.   111-152) is   reduced below 90 percent.   SUBCHAPTER C. PROGRAM ADMINISTRATION           Sec.   532A.0101.     PROGRAM OBJECTIVE. The program's principal   objective is to provide primary and preventive health care through   high deductible program health benefit plans to eligible   individuals.           Sec.   532A.0102.     PROGRAM PROMOTION. The commission shall   promote and provide information about the program to individuals   who:                 (1)     are potentially eligible to participate in the   program; and                 (2)  live in medically underserved areas of this state.           Sec.   532A.0103.     COMMISSION'S AUTHORITY RELATED TO HEALTH   BENEFIT PLAN PROVIDER CONTRACTS. The commission may:                 (1)     enter into contracts with health benefit plan   providers under Section 532A.0107;                 (2)     monitor program health benefit plan providers   through reporting requirements and other means to ensure contract   performance and quality delivery of services;                 (3)     monitor the quality of services delivered to   participants through outcome measurements; and                 (4)     provide payment under the contracts to program   health benefit plan providers.           Sec.   532A.0104.     COMMISSION'S AUTHORITY RELATED TO   ELIGIBILITY AND MEDICAID COORDINATION. The commission may:                 (1)     accept applications for health benefit coverage   under the program and implement program eligibility screening and   enrollment procedures;                 (2)     resolve grievances related to eligibility   determinations; and                 (3)     to the extent possible, coordinate the program   with Medicaid.           Sec.   532A.0105.     THIRD-PARTY ADMINISTRATOR CONTRACT FOR   PROGRAM IMPLEMENTATION. (a) In administering the program, the   commission may contract with a third-party administrator to provide   enrollment and related services.           (b)     If the commission contracts with a third-party   administrator under this section, the commission may:                 (1)     monitor the third-party administrator through   reporting requirements and other means to ensure contract   performance and quality delivery of services; and                 (2)     provide payment under the contract to the   third-party administrator.           (c)     The executive commissioner shall retain all   policymaking authority over the program.           (d)     The commission shall procure each contract with a   third-party administrator, as applicable, through a competitive   procurement process that complies with all federal and state laws.           Sec.   532A.0106.     TEXAS DEPARTMENT OF INSURANCE DUTIES. (a)   At the commission's request, the Texas Department of Insurance   shall provide any necessary assistance with the program. The   department shall monitor the quality of the services provided by   program health benefit plan providers and resolve grievances   related to those providers.           (b)     The commission and the Texas Department of Insurance may   adopt a memorandum of understanding that addresses the   responsibilities of each agency with respect to the program.           (c)     The Texas Department of Insurance, in consultation with   the commission, shall adopt rules as necessary to implement this   section.           Sec.   532A.0107.     HEALTH BENEFIT PLAN PROVIDER CONTRACTS.   The commission shall select through a competitive procurement   process that complies with all federal and state laws and contract   with health benefit plan providers to provide health care services   under the program. To be eligible for a contract under this section,   an entity must:                 (1)  be a Medicaid managed care organization;                   (2)     hold a certificate of authority issued by the   Texas Department of Insurance that authorizes the entity to provide   the types of health care services offered under the program; and                 (3)     satisfy, except as provided by this chapter, any   applicable requirement of the Insurance Code or another insurance   law of this state.           Sec.   532A.0108.     HEALTH CARE PROVIDERS. (a) A health care   provider who provides health care services under the program must   meet certification and licensure requirements required by   commission rules and other law.           (b)     In adopting rules governing the program, the executive   commissioner shall ensure that a health care provider who provides   health care services under the program is reimbursed at a rate that   is at least equal to the rate paid under Medicare for the provision   of the same or substantially similar services.           Sec.   532A.0109.     PROHIBITION ON CERTAIN HEALTH CARE   PROVIDERS. The executive commissioner shall adopt rules that   prohibit a health care provider from providing program health care   services for a reasonable period, as determined by the executive   commissioner, if the health care provider:                 (1)  fails to repay program overpayments; or                 (2)     owns, controls, manages, or is otherwise   affiliated with and has financial, managerial, or adm [Text truncated for display. Full text available on Congress.gov.]