SRC-CTC, BWC S.B. 43 77(R)BILL ANALYSIS Senate Research CenterS.B. 43 By: Zaffirini Health & Human Services 6/18/2001 Enrolled DIGEST AND PURPOSE Currently, the application and eligibility process for children's Medicaid requires a face-to-face interview. S.B. 43 eliminates this requirement to streamline the process and provide for continuous medical assistance eligibility when children are transitioning from Medicaid to CHIP or to private insurers. RULEMAKING AUTHORITY Rulemaking authority is expressly granted to the Health and Human Services Commission or the commissioner or executive director of an agency operating part of the medical assistance program in SECTION 2 (Section 32.025, Human Resources Code) and SECTION 5 (Section 32.053, Human Resources Code) of this bill. Rulemaking authority is expressly granted to the Health and Human Services Commission or an agency operating part of the medical assistance program in SECTION 4 (Sections 32.0261, 32.0262, and 32.0263, Human Resources Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 62.103, Health and Safety Code, to delete existing text relating to the Texas Healthy Kids Corporation. SECTION 2. Amends Section 32.025, Human Resources Code, by adding Subsections (d), (e), and (f), as follows: (d) Requires the Health and Human Services Commission (department) or an agency operating part of the medical assistance program to adopt an application form and procedures for a request for medical assistance provided to a child under 19 years of age that, to the extent allowed by federal law and except as otherwise provided by this section, are the same as the application forms and procedures adopted under Section 62.103 (Application Form and Procedures), Health and Safety Code. (e) Require the department to permit an application requesting medical assistance for a child under 19 years of age to be conducted by mail instead of through a personal appearance at a department office. (f) Authorizes the department or the commissioner or executive director (commissioner) of an agency operating part of the medical assistance program to develop, by rule, certain procedures. SECTION 3. Amends Section 32.026, Human Resources Code, by adding Subsections (d), (e), and (f), as follows: (d) Requires the department to ensure that documentation and verification procedures used in determining and certifying the eligibility and need for medical assistance of a child under 19 years of age, including the documentation and verification procedures used to evaluate the assets and resources of the child, the child's parents, or the child's other caretaker for that purpose, are the same as the documentation and verification procedures used to determine and certify a child's eligibility for coverage under Chapter 62 (Child Health Plan for Certain LowIncome Children), Health and Safety Code, except that the documentation and verification procedures adopted in accordance with this subsection are prohibited from being more stringent that the documentation and verification procedures existing on January 1, 2001, for the determination and verification of a child's eligibility for coverage under Chapter 62, Health and Safety Code. (e) Requires the department to permit a recertification review of the eligibility and need for medical assistance of a child under 19 years of age to be conducted by telephone or mail instead of through a personal appearance at a department office. (f) Sets forth certain requirements for the department in adopting rules under this section. SECTION 4. Amends Chapter 32B, Human Resources Code, by adding Sections 32.0261, 32.0262, and 32.0263, as follows: Sec. 32.0261. CONTINUOUS ELIGIBILITY. Requires the department to adopt rules in accordance with 42. U.S.C. Section 1396a (e)(12), as amended, to provide for a period for continuous eligibility for a child under 19 years of age and requires the child to remain eligible for medical assistance, without additional review by the department and regardless of changes in the child's resources or income, until the earlier of: first anniversary of the date on which the child's eligibility was determined, or the child's 19th birthday. Sec. 32.0262. ELIGIBILITY TRANSITION. (a) Requires the department to develop procedures to ensure that all necessary information regarding a child who will be denied continued medical assistance under this chapter because of an increase in income, assets, or resources but who is eligible for enrollment in the child health plan under Chapter 62, Health and Safety Code, is promptly transmitted to the child health plan in accordance with the standards adopted under Section 62.104(d), Health and Safety Code. (b) Requires the department to develop procedures to ensure that the parent or caretaker of a child who will be denied continued medical assistance under this chapter because of a failure to keep an appointment, including an appointment for decertification eligibility, a failure to provide information, or for another procedural reason, is promptly contacted and informed of certain items. (c) Requires the department to develop materials under this section in consulation with the Health and Human Services Commission and the appropriate agencies administering all or part of the child health plan under Chapter 62, Health and Safety Code. (d) Requires the department, by rule, to adopt procedures to assist a family whose child loses eligibility for medical assistance under this chapter in making a transition for medical assistance under this chapter in making a transition to the child health plan under Chapter 62, Health and Safety Code, with no interruption in coverage. Sec. 32.0263. HEALTH CARE ORIENTATION. (a) Requires the department to require that the parent or guardian of a child under 19 years of age who originally establishes eligibility for medical assistance to take certain actions. Requires the commissioner by rule to develop certain procedures. SECTION 5. Amends Chapter 32B, Human Resources Code, by adding Section 32.053, as follows: Sec. 32.053. COMPLIANCE WITH TEXAS HEALTH STEPS. Requires the commissioner by rule to develop procedures to ensure that recipients of medical assistance who are eligible for Texas Health Steps comply with the regimen of care prescribed by the Texas Health Steps program. SECTION 6. Amends Chapter 553A, Government Code, by adding Section 533.0076, as follows: Sec. 533.0076. LIMITATIONS ON RECIPIENT DISENROLLMENT. Authorizes the department, except as provided by this section and to the extent permitted by federal law, to prohibit a recipient from disenrolling in a managed care plan under this chapter and enrolling in another managed care plan during the 12-month period after the date the recipient initially enrolls in the plan. Authorizes the recipient to disenroll in a managed care plan for any reason and enroll in another managed care plan under this chapter at any time before the 91st day after the date of the recipient's initial enrollment in the original plan. Requires the commission to allow a recipient who is enrolled in a managed care plan under this chapter to disenroll in that plan at any time for cause in accordance with federal law. SECTION 7. Requires a state agency to request the waiver or authorization and delay implementing that provision until the waiver or authorization is granted, if a state agency determines that a waiver or authorization from a federal agency is necessary for implementation. SECTION 8. (a) Requires the commission, notwithstanding Section 32.0261, Human Resources Code, to adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as amended, to provide for a period of continuous eligibility for certain children under 19 years of age. Sets forth certain requirements for these rules. (b) Requires the commission to adopt rules required by this section not later than February 1, 2002. Sets forth certain requirements for these rules. Provides that the rules adopted under this subsection remain in effect until superseded by the rules adopted under Section 32.0261, Human Resources Code, as added by this Act. (c) Provides that this section expires on the date that the rules adopted under Section 32.0261, Human Resources Code, as added by this Act, take effect. SECTION 9. (a) Authorizes the Medicaid legislative oversight committee created under S.B. 1156, 77th Legislature, Regular Session, 2001, to review and make recommendations regarding legislation necessary to accomplish the purposes of Sections 32.025 and 32.026, Human Resources Code, as amended by this Act, and Section 32.0261, Human Resources Code, as added by this Act. (b) Makes application of Subsection (a) of this section contingent upon the passage of S.B. 1156, 77th Legislature, Regular Session, 2001. SECTION 10. (a) Effective date: January 1, 2002, except as otherwise provided by this Act. (b) Provides that Section 32.0261, Human Resources Code, as added by this Act, takes effect September 1, 2002, but the appropriate state agency is prohibited from implementing the 12month period of continuous eligibility prescribed by that section until the date on which the rules adopted under Subsection (c) of this section take effect. (c) Requires the department or appropriate state agency operating part of the medical assistance program to adopt rules required by Section 32.0261, Human Resources Code, as added by this Act, so that the rules take effect in accordance with that section not earlier than September 1, 2002, or later than June 1, 2003. Requires the rules to provide for a 12-month period of continuous eligibility in accordance with that section for a child whose initial or continued eligibility is determined on or after the effective date of the rules. (d) Requires the department or appropriate state agency operating part of the medical assistance program to adopt rules required by Section 32.0262, Human Resources Code, as added by this Act not later than February 1, 2002.