Sec. 1001.080. HEALTH INSURANCE COVERAGE INFORMATION. (a) In this section, "individual's legally authorized representative" means:
(1) a parent, managing conservator, or guardian of an individual, if the individual is a minor;
(2) a guardian of an individual, if the individual has been adjudicated incompetent to manage the individual's personal affairs; or
(3) an agent of the individual authorized under a medical power of attorney for health care.
(b) This section applies to health or mental health benefits, services, or assistance provided by the department that the department anticipates will be impacted by a health insurance exchange as defined by Section 1001.081(a), including:
(1) community primary health care services provided under Chapter 31;
(2) women's and children's health services provided under Chapter 32;
(3) services for children with special health care needs provided under Chapter 35;
(4) epilepsy program assistance provided under Chapter 40;
(5) hemophilia program assistance provided under Chapter 41;
(6) kidney health care services provided under Chapter 42;
(7) human immunodeficiency virus infection and sexually transmitted disease prevention programs and services provided under Chapter 85;
(8) immunization programs provided under Chapter 161;
(9) programs and services provided by the Rio Grande State Center under Chapter 252;
(10) mental health services for adults provided under Chapter 534;
(11) mental health services for children provided under Chapter 534;
(12) programs and services provided by community mental health hospitals under Chapter 552;
(13) programs and services provided by state mental health hospitals under Chapter 552; and
(14) any other health or mental health program or service designated by the department.
(c) Subject to Subsection (d), the department may not provide health or mental health benefits, services, or assistance described in Subsection (b) unless the individual applying to receive the benefits, services, or assistance submits to the department on the form prescribed by the department:
(1) a statement by the individual or the individual's legally authorized representative attesting that the individual does not have access to private health care insurance that provides coverage for the benefit, service, or assistance; or
(2) if the individual has access to private health care insurance that provides coverage for the benefit, service, or assistance, the information and authorization necessary for the department to submit a claim for reimbursement from the insurer for the benefit, service, or assistance.
(d) The department may waive the prohibition under Subsection (c) for an individual or for health or mental health benefits, services, or assistance described in Subsection (b) if the department determines that a benefit, service, or assistance is necessary during a crisis or emergency.
(e) The executive commissioner shall adopt rules necessary to implement this section.
Added by Acts 2013, 83rd Leg., R.S., Ch. 765 (S.B. 1057), Sec. 1, eff. June 14, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.1634, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 2.27, eff. September 1, 2015.
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