Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 370.
STATE CHILDREN'S HEALTH INSURANCE PROGRAM
The Health and Human Services Commission (HHSC or Commission) proposes
to amend Chapter 370, State Children's Health Insurance Program, Subchapter
A, Program Administration, §370.4, Definitions, and Subchapter B, Application
Screening, Referral and Processing Eligibility Criteria, §370.44, Income.
Background and Justification
Currently §370.44 provides for an assets test for CHIP applicants
with a gross monthly income greater than 150% of the federal poverty level
(FPL). Section 62.101(b), Health and Safety Code, allows HHSC to establish
standards regarding the amount and types of assets such families may have
and still be eligible for CHIP. The proposed amendment defines the elements
of the assets test to be implemented. The Commission has determined that the
proposed assets test is necessary to enable HHSC to provide health care coverage
to eligible families that are least able to afford it within the limits of
appropriated funds.
Section-by-Section Summary
Chapter 370 provides a framework for the operation of the CHIP program.
Section 370.4 defines certain terms contained in the chapter. The proposed
amendment to §370.4 adds definitions of "countable liquid assets," "excess
vehicle value," and "household," which are used in the assets test described
in the proposed amendment to §370.44. The amendment also corrects the
order of the defined terms.
Subchapter B sets forth the CHIP eligibility criteria. Section 370.44 describes
income eligibility requirements, including the income levels at which an assets
test will be imposed. Additional language is being proposed to further define
the elements of the assets test. The proposed test permits a family making
application to CHIP to own no more than $5,000 in combined countable liquid
assets and excess vehicle value. Real property, such as a home, is not counted
as an asset.
As defined in the proposed amendment to §370.4, a "countable liquid
asset" means a resource that a CHIP applicant can readily convert to cash
to meet an immediate need. Vehicles counted as an asset include operable and
licensed cars, trucks, motorcycles, SUVs, vans, and motor homes (including
campers and RVs). Vehicles that are not counted as assets include: trailers,
mobile homes, boats, leased vehicles, and vehicles owned by a business.
Vehicles that meet certain conditions, e.g., vehicles that are used more
than 50% of the time to produce income for a CHIP household, may be fully
exempt from being counted as an asset. A CHIP applicant may claim only one
such exemption for vehicles worth more than $15,000. The exemption will apply
to all vehicles that are worth less than $15,000 and that meet one of the
listed conditions. If the household does not have any fully exempt vehicles,
the first $15,000 of the highest value vehicle will not count toward the assets
limit. Similarly, the first $4,650 of all other countable vehicles will not
count toward the assets limit. For example, if the household owns an $18,000
vehicle, only $3,000 will count toward the household's assets limit. If the
household also owns a vehicle worth $8,000, only $3,350 will count toward
the assets limit.
Fiscal Note
Tom Suehs, Deputy Executive Commissioner for Financial Services, has determined
that during the first five years the proposed amendments are in effect there
will be an estimated savings to the state for State Fiscal Year 2004 of $320,687.00
and for State Fiscal Years 2005 through 2008 an estimated savings to the state
each year of $1,154,387.00. Implementation of the proposed amendments will
not result in any fiscal implications for local governments.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro-businesses to comply with the amendments as proposed. This was determined
by interpretation of the rule that small businesses and micro-businesses will
not be required to alter their business practices in order to comply with
the amendments. There are no anticipated economic costs to persons who are
required to comply with the amendments as proposed. There is no anticipated
negative impact on local employment.
Public Benefit
Jason Cooke, Associate Commissioner for Medicaid and CHIP, has determined
that for each year of the first five years the amendments are in effect, the
public will benefit from adoption of the amendments. The anticipated public
benefit, as a result of enforcing the amendments, will be to ensure that health
coverage is only available to children whose families are least able to afford
health coverage.
Regulatory Analysis
HHSC has determined that the proposed amendments are not a "major environmental
rule," as defined by §2001.0225 of the Texas Government Code. "Major
environmental rule" is defined to mean a rule the specific intent of which
is to protect the environment or reduce risk to human health from environmental
exposure and that may adversely affect, in a material way, the economy, a
sector of the economy, productivity, competition, jobs, the environment, or
the public health and safety of a state or a sector of the state. The proposed
amendments are not specifically intended to protect the environment or reduce
risks to human health from environmental exposure.
Takings Impact Assessment
HHSC has determined that the proposed amendments do not restrict or limit
an owner's right to his or her property that would otherwise exist in the
absence of government action and, therefore, do not constitute a taking under §2007.043,
Government Code.
Public Comment
Written comments on the proposal may be submitted to Melissa Lewicki, Policy
Analyst, Texas Health and Human Services Commission, 1100 W. 49th Street,
MC-H310, Austin, Texas 78756-3199, within 30 days of publication of this proposal
in the
Texas Register
.
Public Hearing
A public hearing is scheduled for Monday, March 15, 2004, 1:30 p.m. to
3:00 p.m. The hearing will be held at the Health and Human Services Commission,
Public Hearing Room, Braker Center, Bldg H, 11029 Metric Blvd, Austin, Texas
78758.
Subchapter A. PROGRAM ADMINISTRATION
1 TAC §370.4
Statutory Authority
The amendments are proposed under authority granted to HHSC by Government
Code, §531.033, which authorizes the Commissioner of HHSC to adopt rules
necessary to implement HHSC's duties and the Texas Health and Safety Code, §62.051(d),
which directs HHSC to adopt rules as necessary to implement the Children's
Health Insurance Program.
The proposed amendments affect the Texas Health and Safety Code, Chapter
62, and the Texas Government Code, Chapter 531. No other statutes, articles,
or codes are affected by the proposed amendments.
§370.4.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise:
(1)
"Administrative Contractor" means the entity that performs
administrative services for the CHIP under contract with the Commission.
[
(2)
[
(A)
a child's custodial parent, whether natural or adoptive;
(B)
a child's grandparent, relative or other adult who provides
care for the child;
(C)
an emancipated minor applying for himself/herself; or
(D)
a child's step-parent.
(3)
[
(4)
[
(5)
[
(A)
the child seeking health insurance benefits;
(B)
the child's siblings who live with the child (biological,
adopted, or step-siblings);
(C)
the child's natural or adoptive parents; or
(D)
the child's step-parent.
(6)
[
(7)
"Children's Health Insurance
Program Service Area" or "CSA" means one of the designated areas in the state
that is served by one or more of the CHIP Health Plans or the CHIP Exclusive
Provider Organization.
(8)
"Commission" or "HHSC" means the Health and Human Services
Commission.
(9)
"Community-based Organization"
or "CBO" means an organization that contracts with the Commission to provide
outreach services to applicants for CHIP coverage.
(10)
[
(11)
[
(12)
"Countable liquid assets"
means resources that an applicant can readily convert to cash to meet immediate
needs and whose values are used in calculating a child's eligibility for CHIP,
including, but not limited to:
(A)
cash on hand;
(B)
cash in the bank;
(C)
cash in a TANF (Temporary Assistance to Needy
Families) Electronic Benefit Transfer account;
(D)
the cash value of an Individual Development
Account, Individual Retirement Account, Simplified Employee Pension plan,
and Keogh retirement plan;
(E)
cash value of prepaid burial and funeral plans;
(F)
money remaining from the sale of a homestead;
and
(G)
accessible trust funds.
[
[
(13)
"Enrollment" means the process by which a child determined
to be eligible for CHIP is enrolled in a CHIP health plan serving the CHIP
Service Area in which the child resides.
(14)
"Entrant" means a person who
is not a native born or naturalized citizen of the United States of America.
(15)
"Excess vehicle value" means
a vehicle's wholesale value minus any allowable exemption.
(16)
[
(17)
[
(18)
"Gross budget group income"
means monthly countable income before any payroll deductions.
(19)
[
(20)
"Household" means the budget
group plus any SSI recipient who is
(A)
the child's sibling who lives with the child
(biological, adopted, or step-sibling);
(B)
the child's natural or adoptive parent; or
(C)
the child's step-parent.
(21)
[
(22)
[
[
(23)
[
(24)
[
(25)
[
[
(26)
[
(27)
"TexCare" means the name designated
to publicly identify the operational entity that provides administrative services
for the CHIP program.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on February 9, 2004.
TRD-200400809
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: March 21, 2004
For further information, please call: (512) 424-6576
(2)
"Entrant" means a person who
is not a native born or naturalized citizen of the United States of America.]
(3)
] "Applicant" means an individual
who lives with the child and applies for health insurance coverage on behalf
of the child. An applicant can only be:
(4)
] "Application" means the standardized,
written document issued by TexCare that an applicant must complete to apply
for health care benefits or coverage through CHIP.
(5)
] "Application completion date"
means the calendar date a completed CHIP application is entered into the TexCare
database.
(6)
] "Budget Group" means the group
of individuals who live in the home with the child for whom an application
for health insurance is submitted and whose information is used to establish
family size and calculate income. Individuals receiving Supplemental Security
Income payments are not included in the Budget group. Budget group members
include only:
(7)
] "Children's Health Insurance
Program" or "CHIP" means the Texas State Children's Health Insurance Program
established under Title XXI of the federal Social Security Act (42 U.S.C, §§1397aa,
et seq.) and chapters 62 and 63, Health and Safety Code.
(9)
] "Completed application" means
an application entered into the TexCare database that includes all information
required under §370.23.
(10)
] "Countable income" means
any type of payment that is a regular and predictable gain or a benefit to
a budget group that is not specifically exempted. Regular and predictable
income is income received in one month that is either likely to be received
in the next month and/or was received on a regular and predictable basis in
past months. It does not include income that is not received on a regular
and predictable basis in past months, or is received by the child or sibling
member of the budget group who is enrolled in school.
(11)
"Children's Health Insurance
Program Service Area" or "CSA" means one of the designated areas in the state
that is served by one or more of the CHIP Health Plans or the CHIP Exclusive
Provider Organization.]
(12)
"Community-based Organization"
or "CBO" means an organization that contracts with the Commission to provide
outreach services to applicants for CHIP coverage.]
(14)
] "Exempt income" means income
received by the budget group that is not counted in determining income eligibility.
(15)
] "FPL" means Federal Poverty
Level Income Guidelines.
(16)
] "Health Plan" means a licensed
health maintenance organization, indemnity carrier, or authorized exclusive
provider organization that contracts with the Commission to provide health
benefits coverage to CHIP members.
(17)
] "Income eligibility standard"
means monthly gross budget group income at or below 200% of current (FPL).
A child meets the CHIP income eligibility standard if the budget group's monthly
gross income exceeds the income eligibility standard applied to the child
in the Texas Medicaid Program and is at or below the 200% of FPL CHIP monthly
income standard.
(18)
] "Member" means a child enrolled
in a CHIP Health Plan.
(19)
"Gross budget group income"
means monthly countable income before any payroll deductions.]
(20)
] "Qualified Entrant" means
an alien who applies for CHIP coverage and who, at the time of such application,
satisfies the criteria established under 8 U.S.C. §1641(b).
(21)
] "SSI" means Supplemental
Security Income.
(22)
] "State fiscal year" means
the 12-month period beginning September 1 of each calendar year and ending
August 31 of the following calendar year.
(23)
"TexCare" means the name
designated to publicly identify the operational entity that provides administrative
services for the CHIP program.]
(24)
] "TDHS" means the Texas Department
of Human Services.
Subchapter B. APPLICATION SCREENING, REFERRAL AND PROCESSING