State Codes and Statutes
Statutes > Texas > Health-and-safety-code > Title-2-health > Chapter-75-regional-or-local-health-care-programs-for-employees-of-small-employers
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.
State Codes and Statutes
Statutes > Texas > Health-and-safety-code > Title-2-health > Chapter-75-regional-or-local-health-care-programs-for-employees-of-small-employers
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.
State Codes and Statutes
Statutes >
Texas >
Health-and-safety-code >
Title-2-health >
Chapter-75-regional-or-local-health-care-programs-for-employees-of-small-employers 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.
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