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A BILL TO BE ENTITLED
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AN ACT
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relating to the development and implementation of the Live Well |
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Texas program and the expansion of Medicaid eligibility to provide |
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health benefit coverage to certain individuals; imposing |
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penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle I, Title 4, Government Code, is amended |
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by adding Chapters 537A and 537B to read as follows: |
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CHAPTER 537A. LIVE WELL TEXAS PROGRAM |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 537A.0001. DEFINITIONS. In this chapter: |
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(1) "Basic plan" means the program health benefit plan |
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described by Section 537A.0202. |
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(2) "Eligible individual" means an individual who is |
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eligible to participate in the program. |
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(3) "Participant" means an individual who is: |
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(A) enrolled in a program health benefit plan; or |
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(B) receiving health care financial assistance |
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under Subchapter H. |
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(4) "Plus plan" means the program health benefit plan |
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described by Section 537A.0203. |
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(5) "POWER account" means a personal wellness and |
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responsibility account the commission establishes for a |
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participant under Section 537A.0251. |
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(6) "Program" means the Live Well Texas program |
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established under this chapter. |
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(7) "Program health benefit plan" includes: |
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(A) the basic plan; and |
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(B) the plus plan. |
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(8) "Program health benefit plan provider" means a |
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health benefit plan provider that contracts with the commission |
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under Section 537A.0107 to arrange for the provision of health care |
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services through a program health benefit plan. |
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SUBCHAPTER B. FEDERAL WAIVER FOR LIVE WELL TEXAS PROGRAM |
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Sec. 537A.0051. FEDERAL AUTHORIZATION FOR PROGRAM. (a) |
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Notwithstanding any other law, the executive commissioner shall |
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develop and seek a waiver under Section 1115 of the Social Security |
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Act (42 U.S.C. Section 1315) to the state Medicaid plan to implement |
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the Live Well Texas program to assist individuals in obtaining |
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health benefit coverage through a program health benefit plan or |
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health care financial assistance. |
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(b) The terms of a waiver the executive commissioner seeks |
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under this section must: |
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(1) be designed to: |
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(A) provide health benefit coverage options for |
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eligible individuals; |
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(B) produce better health outcomes for |
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participants; |
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(C) create incentives for participants to |
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transition from receiving public assistance benefits to achieving |
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stable employment; |
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(D) promote personal responsibility and engage |
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participants in making decisions regarding health care based on |
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cost and quality; |
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(E) support participants' self-sufficiency by |
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requiring unemployed participants to be referred to work search and |
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job training programs; |
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(F) support participants who become ineligible |
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to participate in a program health benefit plan in transitioning to |
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private health benefit coverage; and |
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(G) leverage enhanced federal medical assistance |
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percentage funding to minimize or eliminate the need for a program |
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enrollment cap; and |
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(2) allow for the operation of the program consistent |
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with the requirements of this chapter, except to the extent |
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deviation from the requirements is necessary to obtain federal |
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authorization of the waiver. |
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