Bill Text: TX HB3226 | 2023-2024 | 88th Legislature | Introduced


Bill Title: Relating to the development and implementation of the Live Well Texas program to provide health benefit coverage to certain individuals; imposing penalties.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2023-03-15 - Referred to Health Care Reform, Select [HB3226 Detail]

Download: Texas-2023-HB3226-Introduced.html
  88R10277 JG-D
 
  By: Allison H.B. No. 3226
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the development and implementation of the Live Well
  Texas program 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 Chapter 537A to read as follows:
  CHAPTER 537A. LIVE WELL TEXAS PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 537A.0001.  DEFINITIONS. In this chapter:
               (1)  "Basic plan" means the program health benefit plan
  described by Section 537A.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 537A.0203.
               (5)  "POWER account" means a personal wellness and
  responsibility account the commission establishes for a
  participant under Section 537A.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 537A.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. 537A.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 and actively seek employment;
                     (F)  support participants' overall wellness by
  requiring participants to receive preventative care services and
  maintain relationships with preventative care providers;
                     (G)  support participants who become ineligible
  to participate in a program health benefit plan in transitioning to
  private health benefit coverage; and
                     (H)  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.
         Sec. 537A.0052.  FUNDING. Subject to approval of the waiver
  described by Section 537A.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. 537A.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 federal funding
  terminates 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), unless a
  successor program providing federal funding that is at least equal
  to the federal funding under that Act is created.
  SUBCHAPTER C. PROGRAM ADMINISTRATION
         Sec. 537A.0101.  PROGRAM OBJECTIVE. The program's principal
  objective is to provide primary and preventative health care
  through high deductible program health benefit plans to eligible
  individuals.
         Sec. 537A.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. 537A.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 537A.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. 537A.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. 537A.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 shall:
               (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. 537A.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. 537A.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. 537A.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. 537A.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 administrative
  influence over a health care provider who has been suspended or
  prohibited from providing program health care services.
  SUBCHAPTER D. ELIGIBILITY FOR PROGRAM HEALTH BENEFIT COVERAGE
         Sec. 537A.0151.  ELIGIBILITY REQUIREMENTS. (a) An
  individual is eligible to enroll in a program health benefit plan
  if:
               (1)  the individual is:
                     (A)  a citizen or permanent resident of the United
  States; and
                     (B)  a resident of this state;
               (2)  the individual is 19 years of age or older but
  younger than 65 years of age;
               (3)  applying the eligibility criteria in effect in
  this state on December 31, 2022, the individual is not eligible for
  Medicaid; and
               (4)  federal matching funds are 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) to provide benefits to the individual under
  the federal medical assistance program established under Title XIX,
  Social Security Act (42 U.S.C. Section 1396 et seq.).
         (b)  An individual who is a parent or caretaker relative to
  whom 42 C.F.R. Section 435.110 applies is eligible to enroll in a
  program health benefit plan.
         (c)  In determining eligibility for the program, the
  commission shall apply the same eligibility criteria regarding
  residency and citizenship in effect for Medicaid in this state on
  December 31, 2022.
         Sec. 537A.0152.  CONTINUOUS COVERAGE. The commission shall
  ensure that an individual who is initially determined or
  redetermined to be eligible to participate in the program and
  enroll in a program health benefit plan will remain eligible for
  coverage under the plan for a period of 12 months beginning on the
  first day of the month following the date eligibility was
  determined or redetermined, subject to Section 537A.0252(f).
         Sec. 537A.0153.  APPLICATION FORM AND PROCEDURES. (a) The
  executive commissioner shall adopt an application form and
  application procedures for the program. The form and procedures
  must be coordinated with forms and procedures under Medicaid to
  ensure that there is a single consolidated application process to
  seek health benefit 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 an individual to
  apply by mail, over the telephone, or through the Internet.
         Sec. 537A.0154.  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 individuals and enroll eligible individuals in the program.
         (b)  The eligibility screening and enrollment procedures
  must ensure that an individual applying for the program who appears
  eligible for Medicaid is identified and assisted with obtaining
  Medicaid coverage. If the individual is denied Medicaid coverage
  but is determined eligible to enroll in a program health benefit
  plan, the commission shall enroll the individual in a program
  health benefit plan of the individual's choosing and for which the
  individual is eligible without further application or
  qualification.
         (c)  Not later than the 30th day after the date an individual
  submits a complete application form and unless the individual is
  identified and assisted with obtaining Medicaid coverage under
  Subsection (b), the commission shall ensure that the individual's
  eligibility to participate in the program is determined and that
  the individual is provided with information on program health
  benefit plans and program health benefit plan providers. The
  commission shall enroll the individual in the program health
  benefit plan and with the program health benefit plan provider of
  the individual's choosing in a timely manner, as determined by the
  commission.
         (d)  The executive commissioner may establish enrollment
  periods for the program.
         Sec. 537A.0155.  ELIGIBILITY REDETERMINATION PROCESS;
  DISENROLLMENT. (a) Not later than the 90th day before a
  participant's coverage period expires, the commission shall notify
  the participant regarding the eligibility redetermination process
  and request documentation necessary to redetermine the
  participant's eligibility.
         (b)  The commission shall provide written notice of
  termination of eligibility to a participant not later than the 30th
  day before the date the participant's eligibility will terminate.
  The commission shall disenroll the 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 for
  the program, subject to Subchapter H.
         (c)  An individual may submit the requested eligibility
  redetermination documentation not later than the 90th day after the
  date the commission disenrolls the individual from the program. If
  the commission determines that the individual continues to meet
  program eligibility requirements, the commission shall reenroll
  the individual in the program without any additional application
  requirements.
         (d)  An individual who does not complete the eligibility
  redetermination process in accordance with this section and who the
  commission disenrolls from the program may not participate in the
  program for a period of 180 days beginning on the date of
  disenrollment.  This subsection does not apply to an individual:
               (1)  described by Section 537A.0206 or 537A.0208; or
               (2)  who is:
                     (A)  pregnant; or
                     (B)  younger than 21 years of age.
         (e)  At the time the commission disenrolls a participant from
  the program, the commission shall provide to the participant:
               (1)  notice that the participant may be eligible to
  receive health care financial assistance under Subchapter H in
  transitioning to private health benefit coverage; and
               (2)  information on and the eligibility requirements
  for that financial assistance.
  SUBCHAPTER E. BASIC AND PLUS PLANS
         Sec. 537A.0201.  BASIC AND PLUS PLAN COVERAGE GENERALLY.
  (a) The basic and plus plans offered under the program must:
               (1)  comply with this subchapter and coverage
  requirements prescribed by other law; and
               (2)  at a minimum, provide coverage for essential
  health benefits required under 42 U.S.C. Section 18022(b).
         (b)  In modifying covered health benefits under the basic and
  plus plans, the executive commissioner shall consider the health
  care needs of healthy individuals and individuals with special
  health care needs.
         (c)  The basic and plus plans must allow a participant with a
  chronic, disabling, or life-threatening illness to select an
  appropriate specialist as the participant's primary care
  physician.
         Sec. 537A.0202.  BASIC PLAN: COVERAGE AND INCOME
  ELIGIBILITY. (a) The program must include a basic plan that is
  sufficient to meet the basic health care needs of individuals who
  enroll in the plan.
         (b)  The covered health benefits under the basic plan must
  include:
               (1)  primary care physician services;
               (2)  prenatal and postpartum care;
               (3)  specialty care physician visits;
               (4)  home health services, not to exceed 100 visits per
  year;
               (5)  outpatient surgery;
               (6)  allergy testing;
               (7)  chemotherapy;
               (8)  intravenous infusion services;
               (9)  radiation therapy;
               (10)  dialysis;
               (11)  emergency care hospital services;
               (12)  emergency transportation, including ambulance
  and air ambulance;
               (13)  urgent care clinic services;
               (14)  hospitalization, including for:
                     (A)  general inpatient hospital care;
                     (B)  inpatient physician services;
                     (C)  inpatient surgical services;
                     (D)  non-cosmetic reconstructive surgery;
                     (E)  a transplant;
                     (F)  treatment for a congenital abnormality;
                     (G)  anesthesia;
                     (H)  hospice care; and
                     (I)  care in a skilled nursing facility for a
  period not to exceed 100 days per occurrence;
               (15)  inpatient and outpatient behavioral health
  services;
               (16)  inpatient, outpatient, and residential substance
  use treatment;
               (17)  prescription drugs, including tobacco cessation
  drugs;
               (18)  inpatient and outpatient rehabilitative and
  habilitative care, including physical, occupational, and speech
  therapy, not to exceed 60 combined visits per year;
               (19)  medical equipment, appliances, and assistive
  technology, including prosthetics and hearing aids, and the repair,
  technical support, and customization needed for individual use;
               (20)  laboratory and pathology tests and services;
               (21)  diagnostic imaging, including x-rays, magnetic
  resonance imaging, computed tomography, and positron emission
  tomography;
               (22)  preventative care services as described by
  Section 537A.0204; and
               (23)  services under the early and periodic screening,
  diagnostic, and treatment program for participants who are younger
  than 21 years of age.
         (c)  To be eligible for health care benefits under the basic
  plan, an individual who is eligible for the program must have an
  annual household income that is equal to or less than 100 percent of
  the federal poverty level.
         Sec. 537A.0203.  PLUS PLAN: COVERAGE AND INCOME ELIGIBILITY.
  (a) The program must include a plus plan that includes the covered
  health benefits listed in Section 537A.0202 and the following
  additional enhanced health benefits:
               (1)  services related to the treatment of conditions
  affecting the temporomandibular joint;
               (2)  dental care;
               (3)  vision care;
               (4)  notwithstanding Section 537A.0202(b)(18),
  inpatient and outpatient rehabilitative and habilitative care,
  including physical, occupational, and speech therapy, not to exceed
  75 combined visits per year;
               (5)  bariatric surgery; and
               (6)  other services the commission considers
  appropriate.
         (b)  An individual who is eligible for the program and whose
  annual household income exceeds 100 percent of the federal poverty
  level will automatically be enrolled in and receive health benefits
  under the plus plan.  An individual who is eligible for the program
  and whose annual household income is equal to or less than 100
  percent of the federal poverty level may choose to enroll in the
  plus plan.
         (c)  A participant enrolled in the plus plan is required to
  make POWER account contributions in accordance with Section
  537A.0252.
         Sec. 537A.0204.  PREVENTATIVE CARE SERVICES. (a) The
  commission shall provide to each participant a list of health care
  services that qualify as preventative care services based on the
  participant's age, gender, and preexisting conditions. In
  developing the list, the commission shall consult with the federal
  Centers for Disease Control and Prevention.
         (b)  A program health benefit plan shall, at no cost to the
  participant, provide coverage for:
               (1)  preventative care services described by 42 U.S.C.
  Section 300gg-13; and
               (2)  a maximum of $500 per year of preventative care
  services other than those described by Subdivision (1).
         (c)  A participant who receives preventative care services
  not described by Subsection (b) that are covered under the
  participant's program health benefit plan is subject to deductible
  and copayment requirements for the services in accordance with the
  terms of the plan.
         Sec. 537A.0205.  COPAYMENTS. (a) A participant enrolled in
  the basic plan shall pay a copayment for each covered health benefit
  except for a preventative care or family planning service. The
  executive commissioner by rule shall adopt a copayment schedule for
  basic plan services, subject to Subsection (c).
         (b)  Except as provided by Subsection (c), a participant
  enrolled in the plus plan may not be required to pay a copayment for
  a covered service.
         (c)  A participant enrolled in the basic or plus plan shall
  pay a copayment in an amount set by commission rule not to exceed
  $25 for nonemergency use of hospital emergency department services
  unless:
               (1)  the participant has met the cost-sharing maximum
  for the calendar quarter, as prescribed by commission rule;
               (2)  the participant is referred to the hospital
  emergency department by a health care provider;
               (3)  the visit is a true emergency, as defined by
  commission rule; or
               (4)  the participant is pregnant.
         Sec. 537A.0206.  CERTAIN PARTICIPANTS ELIGIBLE FOR STATE
  MEDICAID PLAN BENEFITS. (a) A participant described by 42 C.F.R.
  Section 440.315 who is enrolled in the basic or plus plan is
  entitled to receive under the program all health benefits that
  would be available under the state Medicaid plan.
         (b)  A participant to which this section applies is subject
  to the cost-sharing requirements, including copayment and POWER
  account contribution requirements, of the program health benefit
  plan in which the participant is enrolled.
         (c)  The commission shall develop screening measures to
  identify participants to which this section applies.
         Sec. 537A.0207.  PREGNANT PARTICIPANTS. (a) A participant
  who becomes pregnant while enrolled in the program and who meets the
  eligibility requirements for Medicaid may choose to remain in the
  program or enroll in Medicaid.
         (b)  A pregnant participant described by Subsection (a) who
  is enrolled in the basic or plus plan and who remains in the program
  is:
               (1)  notwithstanding Section 537A.0205, not subject to
  any cost-sharing requirements, including copayment and POWER
  account contribution requirements, of the program health benefit
  plan in which the participant is enrolled until the expiration of
  the sixth month following the month in which the pregnancy ends;
               (2)  entitled to receive as a Medicaid wrap-around
  benefit all Medicaid services a pregnant woman enrolled in Medicaid
  is entitled to receive, including a pharmacy benefit, when the
  participant exceeds coverage limits under the participant's
  program health benefit plan or if a service is not covered by the
  plan; and
               (3)  eligible for additional vision and dental care
  benefits.
         Sec. 537A.0208.  PARENTS AND CARETAKER RELATIVES. (a) A
  parent or caretaker relative to whom 42 C.F.R. Section 435.110
  applies is entitled to receive as a Medicaid wrap-around benefit
  all Medicaid services to which the individual would be entitled
  under the state Medicaid plan that are not covered under the
  individual's program health benefit plan or exceed the plan's
  coverage limits.
         (b)  An individual described by Subsection (a) who chooses to
  participate in the program is subject to the cost-sharing
  requirements, including copayment and POWER account contribution
  requirements, of the program health benefit plan in which the
  individual is enrolled.
  SUBCHAPTER F. PERSONAL WELLNESS AND RESPONSIBILITY (POWER)
  ACCOUNTS
         Sec. 537A.0251.  ESTABLISHMENT AND OPERATION OF POWER
  ACCOUNTS. (a) The commission shall establish a personal wellness
  and responsibility (POWER) account for each participant who is
  enrolled in a program health benefit plan that is funded with money
  contributed in accordance with this subchapter.
         (b)  The commission shall enable each participant to access
  and manage money in and information regarding the participant's
  POWER account through an electronic system. The commission may
  contract with an entity that has appropriate experience and
  expertise to establish, implement, or administer the electronic
  system.
         (c)  Except as otherwise provided by Section 537A.0252, the
  commission shall require each participant to contribute to the
  participant's POWER account in amounts described by that section.
         Sec. 537A.0252.  POWER ACCOUNT CONTRIBUTIONS; DEDUCTIBLE.
  (a) The executive commissioner by rule shall establish an annual
  universal deductible for each participant enrolled in the basic or
  plus plan.
         (b)  To ensure each participant's POWER account contains a
  sufficient amount of money at the beginning of a coverage period,
  the commission shall, before the beginning of that period, fund
  each account with the following amounts:
               (1)  for a participant enrolled in the basic plan, the
  annual universal deductible amount; and
               (2)  for a participant enrolled in the plus plan, the
  difference between the annual universal deductible amount and the
  participant's required annual contribution as determined by the
  schedule established under Subsection (c).
         (c)  The executive commissioner by rule shall establish a
  graduated annual POWER account contribution schedule for
  participants enrolled in the plus plan that:
               (1)  is based on a participant's annual household
  income, with participants whose annual household incomes are less
  than the federal poverty level paying progressively less and
  participants whose annual household incomes are equal to or greater
  than the federal poverty level paying progressively more; and
               (2)  may not require a participant to contribute more
  than a total of five percent of the participant's annual household
  income to the participant's POWER account.
         (d)  A participant's employer may contribute on behalf of the
  participant any amount of the participant's annual POWER account
  contribution. A nonprofit organization may contribute on behalf of
  a participant any amount of the participant's annual POWER account
  contribution.
         (e)  Subject to the contribution cap described by Subsection
  (c)(2) and not before the expiration of the participant's first
  coverage period, the commission shall require a participant who
  uses one or more tobacco products to contribute to the
  participant's POWER account an annual POWER account contribution
  amount that is one percent more than the participant would
  otherwise be required to contribute under the schedule established
  under Subsection (c).
         (f)  An annual POWER account contribution must be paid by or
  on behalf of a participant monthly in installments that are at least
  equal to one-twelfth of the total required contribution. The
  coverage period for a participant whose annual household income
  exceeds 100 percent of the federal poverty level may not begin until
  the first day of the first month following the month in which the
  first monthly installment is received.
         Sec. 537A.0253.  USE OF POWER ACCOUNT MONEY. A participant
  may use money in the participant's POWER account to pay copayments
  and deductible costs the participant's program health benefit plan
  requires. The commission shall issue to each participant an
  electronic payment card that allows the participant to use the card
  to pay the program health benefit plan costs.
         Sec. 537A.0254.  PROGRAM HEALTH BENEFIT PLAN PROVIDER
  REWARDS PROGRAM FOR ENGAGEMENT IN CERTAIN HEALTHY BEHAVIORS;
  SMOKING CESSATION INITIATIVE. (a) A program health benefit plan
  provider shall establish a rewards program through which a
  participant receiving health care through a program health benefit
  plan the program health benefit plan provider offers may earn money
  to be contributed to the participant's POWER account.
         (b)  Under a rewards program, a program health benefit plan
  provider shall contribute money to a participant's POWER account if
  the participant engages in certain healthy behaviors. The
  executive commissioner by rule shall determine:
               (1)  the behaviors in which a participant must engage
  to receive a contribution, which must include behaviors related to:
                     (A)  completion of a health risk assessment;
                     (B)  smoking cessation; and
                     (C)  as applicable, chronic disease management;
  and
               (2)  the amount of money a program health benefit plan
  provider shall contribute for each behavior described by
  Subdivision (1).
         (c)  Subsection (b) does not prevent a program health benefit
  plan provider from contributing money to a participant's POWER
  account if the participant engages in a behavior not specified by
  that subsection or a rule the executive commissioner adopts in
  accordance with that subsection. If a program health benefit plan
  provider chooses to contribute money under this subsection, the
  program health benefit plan provider shall determine the amount of
  money to be contributed for the behavior.
         (d)  A participant may use contributions a program health
  benefit plan provider makes under a rewards program to offset a
  maximum of 50 percent of the participant's required annual POWER
  account contribution the executive commissioner establishes under
  Section 537A.0252.
         (e)  Contributions a program health benefit plan provider
  makes under a rewards program that result in a participant's POWER
  account balance exceeding the participant's required annual POWER
  account contribution may be rolled over into the next coverage
  period in accordance with Section 537A.0256.
         (f)  During the first coverage period of a participant who
  uses one or more tobacco products, a program health benefit plan
  provider shall actively attempt to engage the participant in and
  provide educational materials to the participant on:
               (1)  smoking cessation activities for which the
  participant may receive a monetary contribution under this section;
  and
               (2)  other smoking cessation programs or resources
  available to the participant.
         Sec. 537A.0255.  MONTHLY STATEMENTS. The commission shall
  distribute to each participant with a POWER account a monthly
  statement that includes information on:
               (1)  the participant's POWER account activity during
  the preceding month, including information on the cost of health
  care services delivered to the participant during that month;
               (2)  the balance of money available in the POWER
  account at the time the statement is issued; and
               (3)  the amount of any contributions due from the
  participant.
         Sec. 537A.0256.  POWER ACCOUNT ROLL OVER. (a) The executive
  commissioner by rule shall establish a process in accordance with
  this section to roll over money in a participant's POWER account to
  the succeeding coverage period. The commission shall calculate the
  amount to be rolled over at the time the participant's program
  eligibility is redetermined.
         (b)  For a participant enrolled in the basic plan, the
  commission shall calculate the amount to be rolled over to a
  subsequent coverage period POWER account from the participant's
  current coverage period POWER account based on the amount of money
  remaining in the participant's POWER account from the current
  coverage period.
         (c)  For a participant enrolled in the plus plan who, as
  determined by the commission, timely makes POWER account
  contributions in accordance with this subchapter, the commission
  shall calculate the amount to be rolled over to a subsequent
  coverage period POWER account from the participant's current
  coverage period POWER account based on:
               (1)  the amount of money remaining in the participant's
  POWER account from the current coverage period; and
               (2)  the total amount of money the participant
  contributed to the participant's POWER account during the current
  coverage period.
         (d)  Except as provided by Subsection (e), a participant may
  use money rolled over into the participant's POWER account for the
  succeeding coverage period to offset required annual POWER account
  contributions, as applicable, during that coverage period.
         (e)  A participant enrolled in the basic plan who rolls over
  money into the participant's POWER account for the succeeding
  coverage period and who chooses to enroll in the plus plan for that
  coverage period may use the money rolled over to offset a maximum of
  50 percent of the required annual POWER account contributions for
  that coverage period.
         Sec. 537A.0257.  REFUND. If at the end of a participant's
  coverage period the participant chooses to cease participating in a
  program health benefit plan or is no longer eligible to participate
  in a program health benefit plan, or if the commission disenrolls a
  participant from the program health benefit plan under Section
  537A.0258 for failure to pay required contributions, the commission
  shall refund to the participant any money the participant
  contributed that remains in the participant's POWER account at the
  end of the coverage period or on the disenrollment date.
         Sec. 537A.0258.  PENALTIES FOR FAILURE TO MAKE POWER ACCOUNT
  CONTRIBUTIONS. (a) For a participant whose annual household
  income exceeds 100 percent of the federal poverty level and who
  fails to make a contribution in accordance with Section 537A.0252,
  the commission shall provide a 60-day grace period during which the
  participant may make the contribution without penalty. If the
  participant fails to make the contribution during the grace period,
  the commission shall disenroll the participant from the program
  health benefit plan in which the participant is enrolled and the
  participant may not reenroll in a program health benefit plan
  until:
               (1)  the 181st day after the disenrollment date; and
               (2)  the participant pays any debt accrued due to the
  participant's failure to make the contribution.
         (b)  For a participant enrolled in the plus plan whose annual
  household income is equal to or less than 100 percent of the federal
  poverty level and who fails to make a contribution in accordance
  with Section 537A.0252, the commission shall disenroll the
  participant from the plus plan and enroll the participant in the
  basic plan. A participant enrolled in the basic plan under this
  subsection may not change enrollment to the plus plan until the
  participant's program eligibility is redetermined.
  SUBCHAPTER G. EMPLOYMENT AND WELLNESS INITIATIVES
         Sec. 537A.0301.  GATEWAY TO WORK PROGRAM. (a) The
  commission shall develop and implement a gateway to work program
  to:
               (1)  integrate existing job training and job search
  programs available in this state through the Texas Workforce
  Commission or other appropriate state agencies with the program;
  and
               (2)  provide each participant with general information
  on the job training and job search programs.
         (b)  Under the gateway to work program, the commission shall
  refer each participant who is unemployed or working less than 20
  hours a week to available job search and job training programs.
         (c)  Under the gateway to work program, the executive
  commissioner by rule shall require as a condition to remain in the
  program that each participant who is able to work demonstrate to the
  commission's satisfaction a reasonable effort to secure and
  maintain employment.
         (d)  The commission shall disenroll a participant from the
  program if at the end of the participant's coverage period the
  participant is unable to demonstrate a reasonable effort to secure
  and maintain employment. A participant who is disenrolled from the
  program under this section is ineligible to participate in the
  program for a period of 12 months from the date of disenrollment.
         Sec. 537A.0302.  GATEWAY TO WELLNESS PROGRAM. (a) The
  commission shall develop and implement a gateway to wellness
  program to:
               (1)  integrate existing health care assistance
  programs available in this state through the Texas Medical
  Association, the Texas Department of Insurance, and other
  appropriate state agencies with the program to ensure access to
  preventative care services and providers under the program; and
               (2)  provide each participant with information on
  available preventative care services and providers under the
  program.
         (b)  Under the gateway to wellness program, the executive
  commissioner by rule shall require as a condition to remain in the
  program that each participant receive preventative care services
  during a coverage period.
         (c)  The commission shall disenroll a participant from the
  program if at the end of the participant's coverage period the
  participant did not receive preventative care services required
  under Subsection (b). A participant who is disenrolled from the
  program under this section is ineligible to participate in the
  program for a period of 12 months from the date of disenrollment.
  SUBCHAPTER H. HEALTH CARE FINANCIAL ASSISTANCE FOR CERTAIN
  PARTICIPANTS
         Sec. 537A.0351.  HEALTH CARE FINANCIAL ASSISTANCE FOR
  CONTINUITY OF CARE.  (a)  The commission shall ensure continuity of
  care by providing health care financial assistance in accordance
  with and in the manner described by this subchapter for a
  participant who:
               (1)  the commission disenrolls from a program health
  benefit plan in accordance with Section 537A.0155 because the
  participant's annual household income exceeds the income
  eligibility requirements for enrollment in a program health benefit
  plan; and
               (2)  seeks and obtains private health benefit coverage
  within 12 months following the date of disenrollment.
         (b)  To receive health care financial assistance under this
  subchapter, a participant must provide to the commission, in the
  form and manner the commission requires, documentation showing the
  participant has obtained or is actively seeking private health
  benefit coverage.
         (c)  The commission may not impose an upper income
  eligibility limit on a participant to receive health care financial
  assistance under this subchapter.
         Sec. 537A.0352.  DURATION AND AMOUNT OF HEALTH CARE
  FINANCIAL ASSISTANCE.  (a)  A participant described by Section
  537A.0351 may receive health care financial assistance under this
  subchapter until the first anniversary of the date the commission
  disenrolled the participant from a program health benefit plan.
         (b)  Health care financial assistance the commission makes
  available to a participant under this subchapter:
               (1)  may not exceed the amount described by Section
  537A.0353; and
               (2)  may be used only to pay for eligible services
  described by Section 537A.0354.
         Sec. 537A.0353.  BRIDGE ACCOUNT; FUNDING.  (a)  The
  commission shall establish a bridge account for each participant
  eligible to receive health care financial assistance under Section
  537A.0351.  The account is funded with money the commission
  contributes in accordance with this section.
         (b)  The commission shall enable each participant for whom
  the commission establishes a bridge account to access and manage
  money in and information regarding the participant's account
  through an electronic system.  The commission may contract with the
  same entity described by Section 537A.0251(b) or another entity
  with appropriate experience and expertise to establish, implement,
  or administer the electronic system.
         (c)  The commission shall fund each bridge account in an
  amount equal to $1,000 using money the commission retains or
  recoups:
               (1)  during the roll over process described by Section
  537A.0256;
               (2)  following the issuance of a refund as described by
  Section 537A.0257; or
               (3)  under Subsection (e).
         (d)  The commission may not require a participant to
  contribute money to the participant's bridge account.
         (e)  The commission shall retain or recoup any unexpended
  money in a participant's bridge account at the end of the period for
  which the participant is eligible to receive health care financial
  assistance under this subchapter for the purpose of funding another
  participant's POWER account under Subchapter F or bridge account
  under this subchapter.
         Sec. 537A.0354.  USE OF BRIDGE ACCOUNT MONEY.  (a)  The
  commission shall issue to each participant for whom the commission
  establishes a bridge account an electronic payment card that allows
  the participant to use the card to pay costs for eligible services
  described by Subsection (b).
         (b)  A participant may use money in the participant's bridge
  account to pay:
               (1)  premium costs incurred during the private health
  benefit coverage enrollment process and coverage period; and
               (2)  copayments, deductible costs, and coinsurance
  associated with the private health benefit coverage the participant
  obtains for health care services that would otherwise be
  reimbursable under Medicaid.
         (c) Costs described by Subsection (b)(2) associated with
  eligible services delivered to a participant may be paid by:
               (1)  a participant using the electronic payment card
  issued under Subsection (a); or
               (2)  a health care provider directly charging and
  receiving payment from the participant's bridge account.
         Sec. 537A.0355.  ENROLLMENT COUNSELING.  The commission
  shall provide enrollment counseling to an individual who is seeking
  private health benefit coverage and who is otherwise eligible to
  receive health care financial assistance under this subchapter.
         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 as required by Section
  537A.0051, Government Code, as added by this Act. The commission
  may delay implementing other provisions of this Act until the
  waiver applied for under that 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
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2023.
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