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A BILL TO BE ENTITLED
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AN ACT
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relating to prohibiting a waiting period requirement for coverage |
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under the child health plan program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 62.154, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 62.154. WAITING PERIOD PROHIBITED; CROWD OUT. (a) The |
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[To the extent permitted under Title XXI of the Social Security Act
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(42 U.S.C. Section 1397aa et seq.), as amended, and any other
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applicable law or regulations, the] child health plan may not |
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[must] include a waiting period, but the child health plan [and] may |
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include copayments and other provisions intended to discourage: |
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(1) employers and other persons from electing to |
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discontinue offering coverage for children under employee or other |
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group health benefit plans; and |
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(2) individuals with access to adequate health benefit |
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plan coverage, other than coverage under the child health plan, |
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from electing not to obtain or to discontinue that coverage for a |
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child. |
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(b) A child may enroll in the child health plan program at |
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any time, without regard to any open enrollment period established |
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under the enrollment procedures, [is not subject to a waiting
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period adopted under Subsection (a)] if: |
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(1) the family lost coverage for the child as a result |
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of: |
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(A) termination of employment because of a layoff |
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or business closing; |
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(B) termination of continuation coverage under |
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the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. |
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L. No. 99-272); |
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(C) change in marital status of a parent of the |
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child; |
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(D) termination of the child's Medicaid |
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eligibility because: |
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(i) the child's family's earnings or |
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resources increased; or |
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(ii) the child reached an age at which |
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Medicaid coverage is not available; or |
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(E) a similar circumstance resulting in the |
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involuntary loss of coverage; |
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(2) the family terminated health benefits plan |
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coverage for the child because the cost to the child's family for |
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the coverage exceeded 10 percent of the family's net income; |
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(3) the child has access to group-based health |
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benefits plan coverage and is required to participate in the health |
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insurance premium payment reimbursement program administered by |
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the commission; or |
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(4) the commission has determined that other grounds |
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exist for a good cause exception. |
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[(c)
A child described by Subsection (b) may enroll in the
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child health plan program at any time, without regard to any open
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enrollment period established under the enrollment procedures.
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[(d) The waiting period required by Subsection (a) must:
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[(1)
extend for a period of 90 days after
the last
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date on which the applicant was covered under a health benefits
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plan; and
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[(2)
apply to a child who was covered by a health
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benefits plan at any time during the 90 days before the date of
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application for coverage under the child health plan.] |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2015. |