- Provides for a Texas Health Insurance Risk Pool to sell major medical policies with prescription benefits to consumers with uninsurable medical conditions. This can be secondary coverage for persons with under-age-65 Medicare.
- Provides for a Children's Health Insurance Program (CHIP) offering low cost health care for children of Texas families whose income is 200% of poverty level or less.
- Establishes the Children with Special Health Care needs program. Eligible children with chronic illness, developmental disabilities, and individuals of any age with Cystic Fibrosis may receive medical services.
- Provides that if an HMO terminates your physician, it must extend service for a 90-day period for individuals with disabilities or life threatening illnesses.
- Provides for safeguards of confidentiality regarding HIV testing.
- Requires that group insurance coverage for mental illness provide up to 45 days of inpatient and 60 days of outpatient treatment per calendar year, with no lifetime limits. The co-pay, deductibles, and amount limits for serious mental illness must be the same as for physical illness.
- Provides that health insurance plans cover an acquired brain injury with co-pay, deductible, and limits the same as similarly covered illnesses. Must include coverage for neurological, cognitive and post acute, community-based treatments and therapies.
- Provides that individuals with a catastrophic or terminal illness may sell their life insurance policy for a lump sum payment less than the policy's face value in order to relieve financial burdens.
- Requires state issued managed health care plans to include disease management programs for people with chronic illnesses such as heart disease, respiratory ailments, diabetes, asthma, chronic kidney disease, HIV or AIDS.
- Provides a medicaid buy-in program for employed persons with disabilities.
- Requires a health benefit plan provide coverage for an enrollee older than two years and younger than six years of age who is diagnosed with autism spectrum disorder. Coverage must continue if enrollee continues to need treatment beyond age six.
- Requires that all newborns be screened for heritable diseases and that these children may be eligible for programs for children with special health care needs.
- Allows the issuer of an individual health plan to ask an applicant about prior denial of coverage for information purposes only.
- Provides that a health insurance plan may not use genetic testing for discriminatory purposes, require in utero genetic testing, or use the results of genetic testing to coerce abortion. Individuals have the right to refuse genetic tests and to be informed of test results.
- Provides that Medicaid may pay Medicare coinsurance or deductibles for certain services.
- Requires professional expertise when fitting prescribed wheelchair mobility systems for Medicaid recipients, including children with disabilities.
- Expands health insurance coverage of autism spectrum disorders (ASD) to cover from the date of diagnosis through age nine. This applies to certain private health plans and does not preclude coverage beyond age 10.
- Provides a physician incentive program within the Medicaid program designed to reduce the use of hospital emergency room services by patients in non-emergency situations.
- Risk Pool:
Texas Insurance Code, Chapter 1506
- Children's Health Insurance Program:
Texas Health and Safety Code, Chapter 62
- Children With Special Health Care Needs:
Texas Health and Safety Code, Sections 35.0022, 35.004 - 35.005
- Texas Health Maintenance Organization Act:
Texas Insurance Code, Chapter 843.362
- Consumer Assistance Program: HMO
Texas Insurance Code, Article 3.70-3D
- HIV Related Testing:
Texas Insurance Code, Chapter 545
- Mental Illness:
Texas Insurance Code, Chapter 1355.004
- Traumatic Brain Injury:
Texas Insurance Code, Section 1352.001
- Viatical Settlements:
Texas Insurance Code, Chapter 1111.052
- Disease Management:
Texas Government Code, Section 533.009
- Medicaid Buy-In Program
Texas Government Code, Section 531.02444
- Autism Spectrum Disorder
Texas Insurance Code, Section 1355.015
- Newborn Testing
Texas Health and Safety Code, Section 33.031(a)
- Insurance Denied Coverage
Texas Insurance Code, Section 544.001
- Genetic Testing
Texas Insurance Code, Sections 546.051-.053, 546.101
- Medicaid Coinsurance and Deductible
Texas Human Resources Code, Section 32.050
- Wheelchair Mobility Systems
Texas Human Resources Code, Section 32.0424
- Health Insurance Coverage for Autism Spectrum Disorders
Insurance Code, Section 1355.002
- Texas Department of Insurance
Relevant Federal Laws
U.S. Department of Health and Human Services