HB4639 - Relating to the development and implementation of a veterans health care coverage program to assist certain veterans in obtaining health care coverage.

  89R7660 CMO-D     By: Lalani H.B. No. 4639       A BILL TO BE ENTITLED   AN ACT   relating to the development and implementation of a veterans health   care coverage program to assist certain veterans in obtaining   health care coverage.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle I, Title 4, Government Code, is amended   by adding Chapter 550A to read as follows:   CHAPTER 550A. VETERANS HEALTH CARE COVERAGE PROGRAM           Sec. 550A.0001.  DEFINITIONS. In this chapter:                 (1)     "Eligible individual" means a veteran who is   eligible to participate in the program.                 (2)     "Participant" means a veteran who is enrolled in   the program.                 (3)     "Program" means the veterans health care coverage   program established under this chapter.                 (4)     "Veteran" has the meaning assigned by Section   411.1951.           Sec.   550A.0002.     FEDERAL AUTHORIZATION FOR PROGRAM. (a)   The executive commissioner shall seek a waiver under Section 1115   of the federal Social Security Act (42 U.S.C. Section 1315) to   obtain any federal money available for implementing the program to   assist eligible individuals in obtaining health care coverage.           (b)     The terms of the waiver the executive commissioner seeks   must:                 (1)  be designed to:                       (A)     provide financial assistance for eligible   individuals to obtain health care coverage, including coverage for   mental health services; and                       (B)     encourage participants to seek employment   opportunities, including through programs operated by the Texas   Workforce Commission; 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.   550A.0003.     FUNDING. Subject to approval of the waiver   described by Section 550A.0002, the commission shall implement the   program using federal money obtained for that purpose.           Sec.   550A.0004.     NOT AN ENTITLEMENT. This chapter does not   establish an entitlement to financial assistance for obtaining   health care coverage under the program for eligible individuals.           Sec.   550A.0005.     PROGRAM PROMOTION AND ADMINISTRATION. The   commission shall promote and provide information on the program to   veterans who are potentially eligible to participate in the   program. The commission shall ensure the program's promotion is   designed in a manner to reach as many veterans as possible.           Sec.   550A.0006.     ELIGIBILITY REQUIREMENTS. An individual is   eligible to participate in the program if:                 (1)  the individual:                       (A)  is a resident of this state;                       (B)  is a veteran;                       (C)     is 19 years of age or older but younger than   65 years of age; and                       (D)     applying the eligibility criteria in effect   in this state on December 31, 2024, is not eligible for Medicaid;   and                 (2)     federal money is available to provide benefits to   the individual under the program.           Sec.   550A.0007.     COMMISSION'S AUTHORITY RELATED TO   ELIGIBILITY AND MEDICAID COORDINATION. The commission may:                 (1)     accept applications for program participation 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.   550A.0008.     APPLICATION FORM AND PROCEDURES. (a) The   executive commissioner shall adopt an application form and   application procedures for the program. The form and procedures   may be coordinated with Medicaid forms and procedures to ensure   there is a single consolidated application process to seek health   care coverage under the program or Medicaid.           (b)     To the extent possible, the commission shall make the   application form available in languages other than English.           (c)     The executive commissioner may permit a veteran to apply   by mail, over the telephone, or through the Internet.           Sec.   550A.0009.     ELIGIBILITY SCREENING AND ENROLLMENT. (a)   The executive commissioner shall adopt eligibility screening and   enrollment procedures or use the Texas Integrated Enrollment   Services eligibility determination system or a compatible system to   screen veterans and enroll eligible individuals in the program.           (b)     The eligibility screening and enrollment procedures   must ensure that a veteran applying for the program who appears   eligible for Medicaid is identified and assisted with obtaining   Medicaid coverage. If the veteran is denied Medicaid coverage but   is otherwise determined eligible to participate in the program, the   commission shall enroll the veteran in the program without   additional application or qualification.           (c)     Not later than the 30th day after the date a veteran   submits a complete application form, the commission shall ensure   that the veteran's eligibility to participate in the program is   determined and that the veteran is enrolled in the program if   eligible.           Sec.   550A.0010.     ELIGIBILITY REDETERMINATION AND   DISENROLLMENT. (a) The commission shall redetermine a   participant's eligibility to participate in the program during the   12th month following the date the participant is initially enrolled   in the program or was most recently redetermined eligible for the   program. The commission shall ensure the eligibility   redetermination process is as seamless and contains as little   administrative burden for the participant as possible to facilitate   the participant's successful eligibility redetermination.           (b)     Not later than the 60th day before the expiration of a   participant's coverage period, the commission shall take all   reasonable steps to notify the participant regarding the   eligibility redetermination process and request documentation   necessary to redetermine the participant's eligibility.           (c)     The commission shall disenroll a participant from the   program if:                 (1)     the participant does not submit the requested   eligibility redetermination documentation before the last day of   the participant's coverage period; or                 (2)     the commission, based on the submitted   documentation, determines the participant is no longer eligible to   participate in the program.           Sec.   550A.0011.     SLIDING SCALE SUBSIDIES. (a) The   commission shall ensure a participant receives a sliding scale   subsidy under the program to purchase health benefit coverage.           (b)  A sliding scale subsidy provided to a participant must:                 (1)  be based on:                       (A)     the average health benefit coverage premium   in the market; and                       (B)     a realistic assessment of the participant's   ability to pay a portion of the premium; and                 (2)     include an enhancement for participants who choose   a high deductible health plan with a health savings account.           (c)     The commission shall ensure that counselors are made   available to participants to advise the participants on selecting   health benefit coverage that meets the participant's needs.           (d)  A participant is responsible for paying:                 (1)     any difference between the premium costs   associated with the purchase of health benefit coverage and the   amount of the participant's subsidy under this section; and                 (2)     any copayments associated with the health benefit   coverage, except to the extent the individual receives an   additional subsidy under Section 550A.0012 to pay the copayments.           (e)     If the amount of a subsidy a participant receives under   this section exceeds the premium costs associated with the   participant's purchase of health benefit coverage, the participant   may deposit the excess amount in a health savings account that may   be used only in the manner described by Section 550A.0013(b).           Sec.   550A.0012.     ADDITIONAL COST-SHARING SUBSIDIES. In   addition to providing a subsidy to a participant under Section   550A.0011, the commission shall provide additional subsidies for   coinsurance payments, copayments, deductibles, and other   cost-sharing requirements associated with the participant's health   benefit coverage. The commission shall provide the additional   subsidies on a sliding scale based on income.           Sec.   550A.0013.     DELIVERY OF SUBSIDIES; HEALTH SAVINGS   ACCOUNTS. (a) The commission shall determine the most appropriate   manner for delivering and administering subsidies provided under   Sections 550A.0011 and 550A.0012. In determining the most   appropriate manner, the commission shall consider depositing   subsidy amounts for a participant in a health savings account   established for that participant.           (b)     A health savings account established under this section   may be used only to:                 (1)     pay health benefit coverage premiums and   cost-sharing amounts; and                 (2)     if appropriate, purchase health care-related   goods and services.           Sec.   550A.0014.     RULEMAKING AUTHORITY. The commission shall   adopt rules as necessary to implement the program.          SECTION 2.  As soon as practicable after the effective date   of this Act, the executive commissioner of the Health and Human   Services Commission shall apply for and actively pursue from the   federal Centers for Medicare and Medicaid Services or another   appropriate federal agency the waiver required by Section   550A.0002, Government Code, as added by this Act. The commission   may delay implementing this Act until the waiver applied for under   this section is granted.          SECTION 3.  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 [Text truncated for display. Full text available on Congress.gov.]