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A BILL TO BE ENTITLED
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AN ACT
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relating to presumptive eligibility of certain elderly individuals |
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for home and community-based services under Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.02605 to read as follows: |
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Sec. 32.02605. PRESUMPTIVE ELIGIBILITY OF CERTAIN ELDERLY |
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INDIVIDUALS FOR HOME AND COMMUNITY-BASED SERVICES. (a) In this |
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section, "elderly individual" means an individual who is 65 years |
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of age or older. |
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(b) The executive commissioner by rule shall adopt a program |
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providing for: |
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(1) the determination and certification of |
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presumptive eligibility for medical assistance of an elderly |
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individual who requires a skilled level of nursing care; and |
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(2) the provision through the medical assistance |
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program to the individual of that care in a home or community-based |
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setting instead of in an institutional setting, provided the |
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individual applies for and meets the basic eligibility requirements |
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for medical assistance. |
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(c) The program established under this section must: |
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(1) provide medical assistance benefits under a |
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presumptive eligibility determination for a period of not more than |
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90 days; |
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(2) establish eligibility criteria and a process for |
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determining the entities authorized to make determinations of |
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presumptive eligibility under the program; |
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(3) provide a preliminary screening tool to entities |
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described by Subdivision (2) that will allow representatives of |
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those entities to: |
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(A) make a determination as to whether an |
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applicant is: |
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(i) functionally able to live at home or in |
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a community setting; and |
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(ii) likely to be financially eligible for |
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medical assistance; |
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(B) make the determination under Paragraph |
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(A)(ii) not later than the fourth day after the date a determination |
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is made under Paragraph (A)(i); and |
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(C) initiate the provision of medical assistance |
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benefits not later than the fifth day after the date an applicant is |
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determined eligible under Paragraph (A)(i); and |
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(4) require an applicant to sign a written agreement: |
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(A) attesting to the accuracy of financial and |
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other information the applicant provides and on which presumptive |
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eligibility is based; and |
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(B) acknowledging that: |
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(i) state-funded services are subject to |
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the period prescribed by Subdivision (1); and |
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(ii) the applicant is required to comply |
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with Subsection (d). |
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(d) An applicant who is determined presumptively eligible |
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for medical assistance under the program established by this |
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section must complete an application for medical assistance not |
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later than the 10th day after the date the applicant is screened for |
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functional eligibility under Subsection (c)(3)(A)(i). |
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(e) Not later than the 45th day after the date the |
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commission receives an application under Subsection (d), the |
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commission shall make a final determination of eligibility for |
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medical assistance. |
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(f) To the extent permitted by federal law, the commission |
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shall retroactively apply a final determination of eligibility for |
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medical assistance under Subsection (e) for a period that does not |
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precede the 90th day before the date the application was filed under |
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Subsection (d). |
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(g) The commission shall submit to the standing committees |
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of the senate and house of representatives having jurisdiction over |
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the medical assistance program an annual report that details: |
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(1) the number of individuals determined |
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presumptively eligible for medical assistance under the program |
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established under this section; |
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(2) the savings to the state based on how much |
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institutional care would have cost for individuals determined |
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presumptively eligible for medical assistance under the program |
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established under this section who were later determined eligible |
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for medical assistance; and |
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(3) the number of individuals determined |
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presumptively eligible for medical assistance under the program |
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established under this section who were later determined not |
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eligible for medical assistance and the cost to the state to provide |
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those individuals with home or community-based services before the |
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final determination of eligibility for medical assistance. |
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(h) The report required under Subsection (g) may be combined |
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with any other report required by this chapter or other law. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2023. |