reglab/statecodes huggingface dataset:
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 63 - Health Benefits Plan for Certain Children › Section 63.006. Cost-Sharing Payments

Sec. 63.006.  COST-SHARING PAYMENTS. (a) Except as provided by Subsection (b), the executive commissioner may not require a child who is provided health benefits plan coverage under Section 63.003 and who meets the income eligibility requirement of the medical assistance program under Chapter 32, Human Resources Code, to pay a premium, deductible, coinsurance, or other cost-sharing payment as a condition of health benefits plan coverage under this chapter.
(b)  The executive commissioner may require a child described by Subsection (a) to pay a copayment as a condition of health benefits plan coverage under this chapter that is equal to any copayment required under the child health plan program under Chapter 62.
(c)  The executive commissioner may require a child who is provided health benefits plan coverage under Section 63.003 and who meets the income eligibility requirement of the child health plan program under Chapter 62 to pay a premium, deductible, coinsurance, or other cost-sharing payment as a condition of health benefits plan coverage under this chapter.  The payment must be equal to any premium, deductible, coinsurance, or other cost-sharing payment required under the child health plan program under Chapter 62.
Added by Acts 1999, 76th Leg., ch. 235, Sec. 1, eff. Aug. 30, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0214, eff. April 2, 2015.
Sec. 63.007.  DISALLOWANCE OF MATCHING FUNDS FROM FEDERAL GOVERNMENT.  Expenditures made to provide health benefits plan coverage under this chapter may not be included for the purpose of determining the state children's health insurance expenditures, as that term is defined by 42 U.S.C. Section 1397ee(d)(2)(B), as amended.
Added by Acts 1999, 76th Leg., ch. 235, Sec. 1, eff. Aug. 30, 1999.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 64 - Miscellaneous Provisions › Section 64.001. Teaching Hospital Account

Sec. 64.001.  TEACHING HOSPITAL ACCOUNT.  The Department of State Health Services state-owned multi-categorical teaching hospital account is an account in the general revenue fund.  Money in the account may be appropriated only to the department to provide funding for indigent health care.
Added by Acts 1999, 76th Leg., ch. 1377, Sec. 3.01, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0215, eff. April 2, 2015.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter A. General Provisions › Section 65.001. Definitions

Sec. 65.001.  DEFINITIONS.  In this chapter:
(1)  "Enrollee" means an individual enrolled in the program.
(2)  "Fund" means the trust fund established under Section 65.101.
(3)  "Pharmacy benefit manager" has the meaning assigned by Section 4151.151, Insurance Code.
(4)  "Prescription drug" has the meaning assigned by Section 551.003, Occupations Code.
(5)  "Program" means the prescription drug savings program established under this chapter.
(6)  "Uninsured individual" means an individual without health benefit plan coverage for a prescription drug benefit.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter A. General Provisions › Section 65.002. Construction of Chapter; Purpose

Sec. 65.002.  CONSTRUCTION OF CHAPTER; PURPOSE.  (a)  This chapter does not establish an entitlement to assistance in obtaining benefits for uninsured individuals.
(b)  The purpose of this chapter is to establish a program to provide uninsured individuals access to prescription drug benefits using money from the fund to pay an amount equal to the value of a prescription drug rebate at the point of sale and returning that rebate amount to the fund to ensure the amounts credited to the fund equal the amounts paid from the fund.
(c)  This chapter does not expand the Medicaid program.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter A. General Provisions › Section 65.003. Rules

Sec. 65.003.  RULES.  The executive commissioner shall adopt rules as necessary to implement this chapter.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter B. Establishment and Administration of Prescription Drug Savings Program › Section 65.051. Establishment of Program

Sec. 65.051.  ESTABLISHMENT OF PROGRAM.  (a)  The commission shall develop and design a prescription drug savings program that partners with a pharmacy benefit manager to offer prescription drugs at a discounted rate to uninsured individuals.
(b)  In developing and implementing the program, the commission shall ensure the program benefits do not include prescription drugs used for the elective termination of a pregnancy.
(c)  The executive commissioner shall ensure the program is designed to provide the greatest possible value to uninsured individuals served by the program, while considering the adequacy of the prescription drug formulary, net costs of the drugs to enrollees, cost to the state, and other important factors determined by the commission.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter B. Establishment and Administration of Prescription Drug Savings Program › Section 65.052. General Powers and Duties of Commission Related to Program

Sec. 65.052.  GENERAL POWERS AND DUTIES OF COMMISSION RELATED TO PROGRAM.  (a)  The commission shall oversee the implementation of the program and coordinate the activities of each state agency involved in that implementation.
(b)  The commission shall design the program to be cost neutral by collecting prescription drug rebates after using money in the fund in amounts equal to the rebate amounts to purchase prescription drugs.
(c)  The commission shall develop procedures for accepting applications for program enrollment, including a process to:
(1)  determine eligibility, screening, and enrollment procedures that allow applicants to self attest to the extent authorized by federal law; and
(2)  resolve disputes related to eligibility determinations.
(d)  The commission shall publish on an Internet website all average consumer costs for each prescription drug available through the program.
(e)  The commission and the contracted pharmacy benefit manager shall integrate manufacturer and other third-party patient assistance programs into the program to the extent feasible. A manufacturer or other third party may decline to link the manufacturer's or third party's patient assistance program to the program. The commission shall give preference to integrating patient assistance programs by listing information on those patient assistance programs in a central location on the Internet website described by Subsection (d) that directs patients to those patient assistance programs as appropriate.
(f)  The commission shall ensure the program has access to an adequate pharmacy network and give preference to conducting the program using a state pharmaceutical assistance program.
(g)  The commission is not required to enter into stand-alone contracts under this chapter. The commission may add the program, wholly or partly, to existing contracts to increase efficiency.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter B. Establishment and Administration of Prescription Drug Savings Program › Section 65.053. Pharmacy Benefit Manager Contract, Monitoring, and Reporting Requirements

Sec. 65.053.  PHARMACY BENEFIT MANAGER CONTRACT, MONITORING, AND REPORTING REQUIREMENTS.  (a)  The commission shall contract with a pharmacy benefit manager to provide discounted prescription drugs to enrollees under the program.
(b)  The commission shall monitor through reporting or other methods the contracted pharmacy benefit manager to ensure performance under the contract and quality delivery of services.
(c)  The contracted pharmacy benefit manager shall report to the commission on the commission's request information related to the program, including information on rebate amounts, prescription drug rates contracted with pharmacies, administrative costs, and out-of-pocket costs paid by enrollees at the point of sale of the prescription drugs.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter B. Establishment and Administration of Prescription Drug Savings Program › Section 65.054. Contract Functions

Sec. 65.054.  CONTRACT FUNCTIONS.  (a)  The commission may contract with a third-party administrator or other entity to perform any or all program functions for the commission under this chapter.
(b)  A third-party administrator or other entity may perform tasks under a contract entered into under Subsection (a) that would otherwise be performed by the commission.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter B. Establishment and Administration of Prescription Drug Savings Program › Section 65.055. Community Outreach Campaign

Sec. 65.055.  COMMUNITY OUTREACH CAMPAIGN.  The commission shall conduct or contract to conduct a community outreach and education campaign in the form and manner determined by the commission to provide information on the program's availability to eligible individuals.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter C. Trust Fund; Program Suspension › Section 65.101. Establishment of Fund

Sec. 65.101.  ESTABLISHMENT OF FUND. (a)  A trust fund is established outside the state treasury for the purposes of this chapter.
(b)  The fund consists of:
(1)  gifts, grants, and donations received by this state for the purposes of the fund;
(2)  legislative appropriations of money for the purposes of this chapter;
(3)  federal money available to this state that by law may be used for the purposes of this chapter; and
(4)  interest, dividends, and other income of the fund.
(c)  The commission shall administer the fund as trustee for the benefit of the program established by this chapter.
(d)  Money in the fund may be used only to administer the program and provide program services.
(e)  The commission shall ensure money spent from the fund to assist enrollees in purchasing prescription drugs is cost neutral after collecting the prescription drug rebates under the program.
(f)  The commission may solicit and accept gifts, grants, and donations for the fund.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter C. Trust Fund; Program Suspension › Section 65.102. Sufficient Funding Required

Sec. 65.102.  SUFFICIENT FUNDING REQUIRED.  Notwithstanding any other provision of this chapter, the commission is not required to implement the program unless money is provided and by law made available for deposit to the credit of the fund.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter C. Trust Fund; Program Suspension › Section 65.103. Suspension of Program

Sec. 65.103.  SUSPENSION OF PROGRAM.  On the fourth anniversary of the date the program is established, the commission shall suspend the program and seek legislative approval to continue the program unless the ongoing costs of administering the program are fully funded through enrollee cost sharing.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter D. Program Eligibility and Enrollee Requirements › Section 65.151. Eligibility Criteria

Sec. 65.151.  ELIGIBILITY CRITERIA.  (a)  Except as provided by Subsection (b), an individual is eligible for benefits under the program if the individual is:
(1)  a resident of this state;
(2)  a citizen or lawful permanent resident of the United States; and
(3)  uninsured, as determined by the commission.
(b)  If the commission determines necessary, the commission may consider an applicant's financial vulnerability as an additional factor for determining program eligibility.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter D. Program Eligibility and Enrollee Requirements › Section 65.152. Cost Sharing

Sec. 65.152.  COST SHARING.  (a)  To the extent necessary, the commission shall require enrollees to share the cost of the program, including requiring enrollees to pay a copayment at the point of sale of a prescription drug.
(b)  The commission must:
(1)  allow an enrollee to pay all or part of the enrollee's share from any source the enrollee selects; and
(2)  accept another assistance program if that assistance program wholly or partly covers the enrollee share of the prescription drug cost.
(c)  The commission shall require an enrollee to pay a copayment to compensate the pharmacy, pharmacy benefit manager, and commission for the costs of administering the program in accordance with Subsection (d) and under the methodology determined by the commission.
(d)  Enrollees shall pay the costs of ongoing administration of the program through an additional charge at the point of sale of an eligible prescription drug only if the total number of enrollees in the program allows for the additional charge to be an amount not to exceed the lesser of:
(1)  an amount similar to the amount charged for a prescription drug in other state pharmaceutical assistance programs administered by the commission; or
(2)  10 percent of the total amount charged at the point of sale for the prescription drug.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter E. Operation of Program › Section 65.201. Program Benefits

Sec. 65.201.  PROGRAM BENEFITS.  The commission must approve program benefits offered under this chapter.  The commission shall ensure the benefits comply with all applicable federal and state laws, rules, and regulations.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter E. Operation of Program › Section 65.202. Reporting

Sec. 65.202.  REPORTING.  (a)  A third-party administrator, pharmacy benefit manager, or any other entity the commission contracts with under Section 65.054 shall report to the commission in the form and manner prescribed by the commission on the benefits and services provided under the program.
(b)  The commission shall establish a procedure to monitor the provision of benefits and services under this chapter.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter E. Operation of Program › Section 65.203. Fraud Prevention

Sec. 65.203.  FRAUD PREVENTION.  The executive commissioner by rule shall develop and implement fraud prevention and detection for pharmacy benefit managers, contracted third parties, and other entities involved in the program.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 65 - Prescription Drug Savings Program for Certain Uninsured Individuals › Subchapter E. Operation of Program › Section 65.204. Annual Program Reports

Sec. 65.204.  ANNUAL PROGRAM REPORTS.  Not later than December 1 of each year, the commission shall provide a written report to the governor, lieutenant governor, speaker of the house of representatives, and standing committees of the legislature with primary jurisdiction over the program. The report must include:
(1)  a line-item list of all program administrative costs incurred by the commission;
(2)  the amount of the pharmacy benefit manager and third-party administrator fees;
(3)  the aggregate amounts of rebates anticipated and received for the program; and
(4)  other program expenditures as the commission determines appropriate.
Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021.
2023 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 › Section 75.001. Purpose

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 › Section 75.002. Definitions

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 B. Regional or Local Health Care Program › Section 75.051. Establishment of Program; Multicounty Cooperation

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 B. Regional or Local Health Care Program › Section 75.052. Governance of Program

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 B. Regional or Local Health Care Program › Section 75.053. Operation of Program

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 B. Regional or Local Health Care Program › Section 75.054. Participation by Small Employers; Share of Cost

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 B. Regional or Local Health Care Program › Section 75.055. Additional Funding

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.
(b-1)  Expired.
(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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 C. Health Care Services and Benefits › Section 75.101. Alternative Programs Authorized; Program Objectives

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 C. Health Care Services and Benefits › Section 75.102. Health Benefit Plan Coverage

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 C. Health Care Services and Benefits › Section 75.103. Other Health Benefit Plans or Programs

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 C. Health Care Services and Benefits › Section 75.104. Health Care Services

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 D. Texas Health Opportunity Pool Funds › Section 75.151. Definition

Text of section effective until April 01, 2025
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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.32, eff. April 1, 2025.
2023 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 D. Texas Health Opportunity Pool Funds › Section 75.151. Definition

Text of section effective on April 01, 2025
Sec. 75.151.  DEFINITION.  In this subchapter, "health opportunity pool trust fund" means the trust fund established under Subchapter D, Chapter 526, Government Code.
Added by Acts 2007, 80th Leg., R.S., Ch. 268 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.32, eff. April 1, 2025.
2023 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 D. Texas Health Opportunity Pool Funds › Section 75.152. Funding Authorized

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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
2023 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 D. Texas Health Opportunity Pool Funds › Section 75.153. Eligibility for Funds; Statewide Eligibility Criteria

Text of section effective until April 01, 2025
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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.33, eff. April 1, 2025.
2023 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 D. Texas Health Opportunity Pool Funds › Section 75.153. Eligibility for Funds; Statewide Eligibility Criteria

Text of section effective on April 01, 2025
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 526.0152, 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 526.0157, 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 (S.B. 10), Sec. 13(a), eff. September 1, 2007.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.33, eff. April 1, 2025.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 76 - Federally Qualified Health Center Primary Care Access Program › Subchapter A. General Provisions › Section 76.001. Purposes

Sec. 76.001.  PURPOSES.  The purposes of this chapter are to:
(1)  increase access to primary care services at federally qualified health centers for low-income or at-risk individuals;
(2)  improve the health of the employees of participating employers and their families by improving access to health care;
(3)  contribute to economic development by assisting small businesses in remaining competitive through employment of a healthy workforce and provision of health care benefits that attract employees; and
(4)  encourage innovative solutions for providing and funding health care services and benefits for participating employees.
Added by Acts 2023, 88th Leg., R.S., Ch. 108 (S.B. 2193), Sec. 1, eff. May 19, 2023.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 76 - Federally Qualified Health Center Primary Care Access Program › Subchapter A. General Provisions › Section 76.002. Definitions

Sec. 76.002.  DEFINITIONS.  In this chapter:
(1)  "Department of insurance" means the Texas Department of Insurance.
(2)  "Employee" means an individual who is employed by an employer for compensation.  The term includes a partner of a partnership and a proprietor of a sole proprietorship.
(3)  "Federally qualified health center" has the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
(4)  "Program" means a primary care access program a federally qualified health center establishes and operates under this chapter.
Added by Acts 2023, 88th Leg., R.S., Ch. 108 (S.B. 2193), Sec. 1, eff. May 19, 2023.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 76 - Federally Qualified Health Center Primary Care Access Program › Subchapter B. Primary Care Access Program › Section 76.051. Establishment and Operation of Program

Sec. 76.051.  ESTABLISHMENT AND OPERATION OF PROGRAM.  (a)  A federally qualified health center may establish and operate a primary care access program for the provision of primary care services and benefits directly to the employees of participating employers and their dependents within the service area of the federally qualified health center.
(b)  A program operated under this chapter shall, within the service area of the federally qualified health center and to the extent practicable:
(1)  reduce the number of individuals who lack access to primary care services;
(2)  reduce the cost of primary care services for small business employers and their employees;
(3)  promote preventive care and reduce the incidence of preventable health conditions, such as heart disease, cancer, diabetes, and low birth weight in infants;
(4)  promote efficient and collaborative delivery of primary care services;
(5)  serve as a model for the innovative use of health information technology; and
(6)  provide fair payment rates for participating health care providers.
(c)  A federally qualified health center may require that participating employees and dependents obtain primary health care services provided under a program only from health care providers at the federally qualified health center.
(d)  A federally qualified health center that operates a program under this subchapter is not subject to regulation by the department of insurance as an insurer or health maintenance organization.
Added by Acts 2023, 88th Leg., R.S., Ch. 108 (S.B. 2193), Sec. 1, eff. May 19, 2023.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 76 - Federally Qualified Health Center Primary Care Access Program › Subchapter B. Primary Care Access Program › Section 76.052. Participation by Employers; Share of Cost

Sec. 76.052.  PARTICIPATION BY EMPLOYERS; SHARE OF COST.  (a)  A federally qualified health center may establish program participation criteria for employers, employees of the employer, and the employees' dependents.
(b)  A federally qualified health center may:
(1)  require participating employers and their employees to pay a share of the premium or other cost of the primary care services;
(2)  contract with a health foundation or other nonprofit organization to support payment of the employer's or employee's share under Subdivision (1); and
(3)  screen employees and their dependents for eligibility to enroll in other state programs and for federal subsidies in the health insurance marketplace.
Added by Acts 2023, 88th Leg., R.S., Ch. 108 (S.B. 2193), Sec. 1, eff. May 19, 2023.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 76 - Federally Qualified Health Center Primary Care Access Program › Subchapter B. Primary Care Access Program › Section 76.053. Funding

Sec. 76.053.  FUNDING.  (a)  In addition to grants awarded under Subchapter C, a federally qualified health center may accept gifts, grants, or donations from any source to administer and finance the program.
(b)  A federally qualified health center shall actively solicit gifts, grants, and donations to:
(1)  fund primary care services and benefits provided under the program; and
(2)  reduce the cost of participation in the program for employers and their employees.
Added by Acts 2023, 88th Leg., R.S., Ch. 108 (S.B. 2193), Sec. 1, eff. May 19, 2023.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 76 - Federally Qualified Health Center Primary Care Access Program › Subchapter C. Primary Care Access Grant Program › Section 76.101. Grant Program

Sec. 76.101.  GRANT PROGRAM.  (a)  The department of insurance, in collaboration with the commission, shall establish and administer a grant program to award grants to federally qualified health centers operating a program under this chapter.
(b)  In awarding a grant under this section, the department of insurance shall consider whether the program will accomplish the purposes of this chapter and meet the objectives established under Section 76.051(b).
(c)  The department of insurance shall establish performance objectives for a grant recipient and monitor whether the recipient meets those objectives.
(d)  In addition to money appropriated by the legislature, the department of insurance may accept gifts, grants, or donations from any source to administer and finance the grant program.
Added by Acts 2023, 88th Leg., R.S., Ch. 108 (S.B. 2193), Sec. 1, eff. May 19, 2023.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle C - Programs Providing Health Care Benefits and Services › Chapter 76 - Federally Qualified Health Center Primary Care Access Program › Subchapter C. Primary Care Access Grant Program › Section 76.102. Report

Sec. 76.102.  REPORT.  Not later than December 1 of each even-numbered year, the department of insurance and the commission shall jointly submit to the governor, the lieutenant governor, and the speaker of the house of representatives a report:
(1)  evaluating the success of the program in accomplishing the purposes of this chapter; and
(2)  recommending any legislative or other action necessary to facilitate or improve the program.
Added by Acts 2023, 88th Leg., R.S., Ch. 108 (S.B. 2193), Sec. 1, eff. May 19, 2023.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle D - Prevention, Control, and Reports of Diseases; Public Health Disasters and Emergencies › Chapter 81 - Communicable Diseases; Public Health Disasters; Public Health Emergencies › Subchapter A. General Provisions › Section 81.001. Short Title

Sec. 81.001.  SHORT TITLE.  This chapter may be cited as the Communicable Disease Prevention and Control Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle D - Prevention, Control, and Reports of Diseases; Public Health Disasters and Emergencies › Chapter 81 - Communicable Diseases; Public Health Disasters; Public Health Emergencies › Subchapter A. General Provisions › Section 81.002. Responsibility of State and Public

Sec. 81.002.  RESPONSIBILITY OF STATE AND PUBLIC.  The state has a duty to protect the public health.  Each person shall act responsibly to prevent and control communicable disease.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle D - Prevention, Control, and Reports of Diseases; Public Health Disasters and Emergencies › Chapter 81 - Communicable Diseases; Public Health Disasters; Public Health Emergencies › Subchapter A. General Provisions › Section 81.004. Administration of Chapter

Sec. 81.004.  ADMINISTRATION OF CHAPTER.  (a)  The commissioner is responsible for the general statewide administration of this chapter.
(b)  The executive commissioner may adopt rules necessary for the effective administration and implementation of this chapter.
(c)  A designee of the executive commissioner may exercise a power granted to or perform a duty imposed on the executive commissioner under this chapter except as otherwise required by law.
(d)  A designee of the commissioner may exercise a power granted to or perform a duty imposed on the commissioner under this chapter except as otherwise required by law.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.  Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.168, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0217, eff. April 2, 2015.
2023 Texas Statutes › Health and Safety Code › Title 2 - Health › Subtitle D - Prevention, Control, and Reports of Diseases; Public Health Disasters and Emergencies › Chapter 81 - Communicable Diseases; Public Health Disasters; Public Health Emergencies › Subchapter A. General Provisions › Section 81.005. Contracts

Sec. 81.005.  CONTRACTS.  The department may enter into contracts or agreements with persons as necessary to implement this chapter.  The contracts or agreements may provide for payment by the state for materials, equipment, and services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.