CHAPTER 75. REGIONAL OR LOCAL HEALTH CARE PROGRAMS FOR EMPLOYEES OF SMALL EMPLOYERS - Texas Statutes

HEALTH AND SAFETY CODE

TITLE 2. HEALTH

SUBTITLE C. PROGRAMS PROVIDING HEALTH CARE BENEFITS AND SERVICES

CHAPTER 75. REGIONAL OR LOCAL HEALTH CARE PROGRAMS FOR EMPLOYEES

OF SMALL EMPLOYERS

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 75.001. PURPOSE. The purpose of this chapter is to:

(1) improve the health of employees of small employers and their

families by improving the employees' access to health care and by

reducing the number of those employees who are uninsured;

(2) reduce the likelihood that those employees and their

families will require services from state-funded entitlement

programs such as Medicaid;

(3) contribute to economic development by helping small

businesses remain competitive with a healthy workforce and health

care benefits that will attract employees; and

(4) encourage innovative solutions for providing and funding

health care services and benefits.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.002. DEFINITIONS. In this chapter:

(1) "Employee" means an individual employed by an employer. The

term includes a partner of a partnership and the proprietor of a

sole proprietorship.

(2) "Governing body" means:

(A) the commissioners courts of the counties participating in a

regional health care program;

(B) the commissioners court of a county participating in a local

health care program; or

(C) the governing body of the joint council, nonprofit entity

exempt from federal taxation, or other entity that operates a

regional or local health care program.

(3) "Local health care program" means a local health care

program operating in one county and established for the benefit

of the employees of small employers under Subchapter B.

(4) "Regional health care program" means a regional health care

program operating in two or more counties and established for the

benefit of the employees of small employers under Subchapter B.

(5) "Small employer" means a person who employed an average of

at least two employees but not more than 50 employees on business

days during the preceding calendar year and who employs at least

two employees on the first day of the plan year.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

SUBCHAPTER B. REGIONAL OR LOCAL HEALTH CARE PROGRAM

Sec. 75.051. ESTABLISHMENT OF PROGRAM; MULTICOUNTY COOPERATION.

(a) The commissioners court of a county may, by order, establish

or participate in a local health care program under this

subchapter.

(b) The commissioners courts of two or more counties may, by

joint order, establish or participate in a regional health care

program under this subchapter.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.052. GOVERNANCE OF PROGRAM. (a) A regional health care

program may be operated subject to the direct governance of the

commissioners courts of the participating counties. A local

health care program may be operated subject to the direct

governance of the commissioners court of the participating

county. A regional or local health care program may be operated

by a joint council, tax-exempt nonprofit entity, or other entity

that:

(1) operates the program under a contract with the commissioners

court or courts, as applicable; or

(2) is an entity in which the county or counties participate or

that is established or designated by the commissioners court or

courts, as applicable, to operate the program.

(b) In selecting an entity described by Subsection (a)(1) or (2)

to operate a regional or local health care program, the

commissioners court or courts, as applicable, shall require, to

the extent possible, that the entity be authorized under federal

law to accept donations on a basis that is tax-deductible or

otherwise tax-advantaged for the contributor.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.053. OPERATION OF PROGRAM. A regional or local health

care program provides health care services or benefits to the

employees of participating small employers who are located within

the boundaries of the participating county or counties, as

applicable. A program may also provide services or benefits to

the dependents of those employees.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.054. PARTICIPATION BY SMALL EMPLOYERS; SHARE OF COST.

Subject to Section 75.153, the governing body may establish

criteria for participation in a regional or local health care

program by small employers, the employees of the small employers,

and their dependents. The criteria must require that

participating employers and participating employees pay a share

of the premium or other cost of the program.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.055. ADDITIONAL FUNDING. (a) A governing body may

accept and use state money made available through an

appropriation from the general revenue fund or a gift, grant, or

donation from any source to operate the regional or local health

care program and to provide services or benefits under the

program.

(b) A governing body may apply for and receive funding from the

health opportunity pool trust fund under Subchapter D.

(c) A governing body shall actively solicit gifts, grants, and

donations to:

(1) fund services and benefits provided under the regional or

local health care program; and

(2) reduce the cost of participation in the program for small

employers and their employees.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

SUBCHAPTER C. HEALTH CARE SERVICES AND BENEFITS

Sec. 75.101. ALTERNATIVE PROGRAMS AUTHORIZED; PROGRAM

OBJECTIVES. In developing a regional or local health care

program, a governing body may provide health care services or

benefits as described by this subchapter or may develop another

type of program to accomplish the purposes of this chapter. A

regional or local health care program must be developed, to the

extent practicable, to:

(1) reduce the number of individuals without health benefit plan

coverage within the boundaries of the participating county or

counties;

(2) address rising health care costs and reduce the cost of

health care services or health benefit plan coverage for small

employers and their employees within the boundaries of the

participating county or counties;

(3) promote preventive care and reduce the incidence of

preventable health conditions, such as heart disease, cancer, and

diabetes and low birth weight in infants;

(4) promote efficient and collaborative delivery of health care

services;

(5) serve as a model for the innovative use of health

information technology to promote efficient delivery of health

care services, reduce health care costs, and improve the health

of the community; and

(6) provide fair payment rates for health care providers.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.102. HEALTH BENEFIT PLAN COVERAGE. (a) A regional or

local health care program may provide health care benefits to the

employees of small employers by purchasing or facilitating the

purchase of health benefit plan coverage for those employees from

a health benefit plan issuer, including coverage under:

(1) a small employer health benefit plan offered under Chapter

1501, Insurance Code;

(2) a standard health benefit plan offered under Chapter 1507,

Insurance Code; or

(3) any other health benefit plan available in this state.

(b) The governing body may form one or more cooperatives under

Subchapter B, Chapter 1501, Insurance Code.

(c) Notwithstanding Chapter 1251, Insurance Code, an insurer may

issue a group accident and health insurance policy, including a

group contract issued by a group hospital service corporation, to

cover the employees of small employers participating in a

regional or local health care program. The group policyholder of

a policy issued in accordance with this subsection is the

governing body or the designee of the governing body.

(d) A health maintenance organization may issue a health care

plan to cover the employees of small employers participating in a

regional or local health care program. The group contract holder

of a contract issued in accordance with this subsection is the

governing body or the designee of the governing body.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.103. OTHER HEALTH BENEFIT PLANS OR PROGRAMS. To the

extent authorized by federal law, the governing body may

establish or facilitate the establishment of self-funded health

benefit plans or may facilitate the provision of health benefit

coverage through health savings accounts and high-deductible

health plans.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.104. HEALTH CARE SERVICES. (a) A regional or local

health care program may contract with health care providers

within the boundaries of the participating county or counties to

provide health care services directly to the employees of

participating small employers and the dependents of those

employees.

(b) A regional or local health care program shall allow any

individual who receives state premium assistance to buy into the

health benefit plan offered by the regional or local health care

program.

(c) A governing body that operates a regional or local health

care program under this section may require that participating

employees and dependents obtain health care services only from

health care providers that contract to provide those services

under the program and may limit the health care services provided

under the program to services provided within the boundaries of

the participating county or counties.

(d) A governing body operating a regional or local health care

program operated under this section is not an insurer or health

maintenance organization and the program is not subject to

regulation by the Texas Department of Insurance.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

SUBCHAPTER D. TEXAS HEALTH OPPORTUNITY POOL FUNDS

Sec. 75.151. DEFINITION. In this subchapter, "health

opportunity pool trust fund" means the trust fund established

under Subchapter N, Chapter 531, Government Code.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.152. FUNDING AUTHORIZED. Notwithstanding any other law,

a regional or local health care program may apply for funding

from the health opportunity pool trust fund and the fund may

provide funding in accordance with this subchapter.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.

Sec. 75.153. ELIGIBILITY FOR FUNDS; STATEWIDE ELIGIBILITY

CRITERIA. To be eligible for funding from money in the health

opportunity pool trust fund, a regional or local health care

program must:

(1) comply with any requirement imposed under the waiver

obtained under Section 531.502, Government Code, including, to

the extent applicable, any requirement that health care benefits

or services provided under the program be provided in accordance

with statewide eligibility criteria; and

(2) provide health care benefits or services under the program

to a person receiving premium payment assistance for health

benefits coverage through a program established under Section

531.507, Government Code, regardless of whether the person is an

employee, or dependent of an employee, of a small employer.

Added by Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 13(a), eff. September 1, 2007.