1-1 AN ACT
1-2 relating to eligibility for and enrollment in certain medical
1-3 assistance programs, including simplifying the certification
1-4 process for medical assistance provided to children.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subsection (b), Section 62.103, Health and Safety
1-7 Code, is amended to read as follows:
1-8 (b) The form and procedures must be coordinated with forms
1-9 and procedures under the Medicaid program [and those used by the
1-10 Texas Healthy Kids Corporation] to ensure that[, to the extent
1-11 possible,] there is a single consolidated application to seek
1-12 assistance under this chapter or the Medicaid program [or from the
1-13 corporation].
1-14 SECTION 2. Section 32.025, Human Resources Code, is amended
1-15 by adding Subsections (d), (e), and (f) to read as follows:
1-16 (d) The department shall adopt an application form and
1-17 procedures for a request for medical assistance provided to a child
1-18 under 19 years of age. To the extent allowed by federal law and
1-19 except as otherwise provided by this section, the application form
1-20 and procedures must be the same as the form and procedures adopted
1-21 under Section 62.103, Health and Safety Code. The department shall
1-22 coordinate the form and procedures adopted under this subsection
1-23 with the form and procedures adopted under Section 62.103, Health
1-24 and Safety Code, to ensure that there is a single consolidated
1-25 application for a child under 19 years of age to seek medical
2-1 assistance or to request coverage under the state child health plan
2-2 under Chapter 62, Health and Safety Code.
2-3 (e) The department shall permit an application requesting
2-4 medical assistance for a child under 19 years of age to be
2-5 conducted by mail instead of through a personal appearance at a
2-6 department office.
2-7 (f) The commissioner by rule may develop procedures by
2-8 which:
2-9 (1) any office of a health and human services agency
2-10 may accept an application requesting medical assistance for a child
2-11 under 19 years of age; and
2-12 (2) the department may contract with hospital
2-13 districts, hospitals, including state-owned teaching hospitals,
2-14 federally qualified health centers, and county health departments
2-15 to accept applications requesting medical assistance for a child
2-16 under 19 years of age.
2-17 SECTION 3. Section 32.026, Human Resources Code, is amended
2-18 by adding Subsections (d), (e), and (f) to read as follows:
2-19 (d) In adopting rules under this section, the department
2-20 shall ensure, to the extent allowed by federal law, that
2-21 documentation and verification procedures used in determining and
2-22 certifying the eligibility and need for medical assistance of a
2-23 child under 19 years of age, including the documentation and
2-24 verification procedures used to evaluate the assets and resources
2-25 of the child, the child's parents, or the child's other caretaker
2-26 for that purpose, are the same as the documentation and
3-1 verification procedures used to determine and certify a child's
3-2 eligibility for coverage under Chapter 62, Health and Safety Code,
3-3 except that the documentation and verification procedures adopted
3-4 in accordance with this subsection may not be more stringent than
3-5 the documentation and verification procedures existing on January
3-6 1, 2001, for determination and certification of a child's
3-7 eligibility for coverage under Chapter 62, Health and Safety Code.
3-8 (e) The department shall permit a recertification review of
3-9 the eligibility and need for medical assistance of a child under 19
3-10 years of age to be conducted by telephone or mail instead of
3-11 through a personal appearance at a department office.
3-12 (f) In adopting rules under this section, the department
3-13 shall ensure, to the extent allowed by federal law, that forms and
3-14 procedures used in conducting a recertification review of the
3-15 eligibility and need for medical assistance of a child under 19
3-16 years of age, including documentation and verification procedures,
3-17 are the same as the forms and procedures used to determine and
3-18 certify a child's renewal of coverage under Chapter 62, Health and
3-19 Safety Code.
3-20 SECTION 4. Subchapter B, Chapter 32, Human Resources Code,
3-21 is amended by adding Sections 32.0261, 32.0262, and 32.0263 to read
3-22 as follows:
3-23 Sec. 32.0261. CONTINUOUS ELIGIBILITY. The department shall
3-24 adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as
3-25 amended, to provide for a period of continuous eligibility for a
3-26 child under 19 years of age who is determined to be eligible for
4-1 medical assistance under this chapter. The rules shall provide
4-2 that the child remains eligible for medical assistance, without
4-3 additional review by the department and regardless of changes in
4-4 the child's resources or income, until the earlier of:
4-5 (1) the first anniversary of the date on which the
4-6 child's eligibility was determined; or
4-7 (2) the child's 19th birthday.
4-8 Sec. 32.0262. ELIGIBILITY TRANSITION. (a) The department
4-9 shall develop procedures to ensure that all necessary information
4-10 regarding a child who will be denied continued medical assistance
4-11 under this chapter because of an increase in income, assets, or
4-12 resources but who is eligible for enrollment in the child health
4-13 plan under Chapter 62, Health and Safety Code, is promptly
4-14 transmitted to the child health plan in accordance with the
4-15 standards established under Section 62.104(d), Health and Safety
4-16 Code.
4-17 (b) The department shall develop procedures to ensure that
4-18 the parent or caretaker of a child who will be denied continued
4-19 medical assistance under this chapter because of a failure to keep
4-20 an appointment, including an appointment for recertification of
4-21 eligibility, a failure to provide information, or for another
4-22 procedural reason, is promptly contacted and informed of:
4-23 (1) the need to recertify eligibility for continued
4-24 medical assistance under this chapter; and
4-25 (2) the availability of medical coverage under the
4-26 child health plan under Chapter 62, Health and Safety Code.
5-1 (c) The department shall develop materials under this
5-2 section in consultation with the Health and Human Services
5-3 Commission and the appropriate agencies administering all or part
5-4 of the child health plan under Chapter 62, Health and Safety Code.
5-5 (d) The department by rule shall adopt procedures to assist
5-6 a family whose child loses eligibility for medical assistance under
5-7 this chapter in making a transition to the child health plan under
5-8 Chapter 62, Health and Safety Code, with no interruption in
5-9 coverage.
5-10 Sec. 32.0263. HEALTH CARE ORIENTATION. (a) The department
5-11 shall require that the parent or guardian of a child under 19 years
5-12 of age who originally establishes eligibility for medical
5-13 assistance must:
5-14 (1) attend an in-person counseling session with a
5-15 department representative not later than the 31st day after the
5-16 date the child originally establishes eligibility; or
5-17 (2) accompany the child to an appointment with a
5-18 health care provider for a comprehensive health care orientation
5-19 not later than the 61st day after the date the child originally
5-20 establishes eligibility.
5-21 (b) The commissioner by rule shall develop procedures to
5-22 verify that:
5-23 (1) the parent or guardian of the child who originally
5-24 establishes eligibility complies with the requirement of Subsection
5-25 (a)(2), if applicable; and
5-26 (2) the child is provided a comprehensive health care
6-1 orientation at the appointment with the health care provider.
6-2 SECTION 5. Subchapter B, Chapter 32, Human Resources Code,
6-3 is amended by adding Section 32.053 to read as follows:
6-4 Sec. 32.053. COMPLIANCE WITH TEXAS HEALTH STEPS. The
6-5 commissioner by rule shall develop procedures to ensure that
6-6 recipients of medical assistance who are eligible for Texas Health
6-7 Steps comply with the regimen of care prescribed by the Texas
6-8 Health Steps program.
6-9 SECTION 6. Subchapter A, Chapter 533, Government Code, is
6-10 amended by adding Section 533.0076 to read as follows:
6-11 Sec. 533.0076. LIMITATIONS ON RECIPIENT DISENROLLMENT.
6-12 (a) Except as provided by Subsections (b) and (c), and to the
6-13 extent permitted by federal law, the commission may prohibit a
6-14 recipient from disenrolling in a managed care plan under this
6-15 chapter and enrolling in another managed care plan during the
6-16 12-month period after the date the recipient initially enrolls in a
6-17 plan.
6-18 (b) At any time before the 91st day after the date of a
6-19 recipient's initial enrollment in a managed care plan under this
6-20 chapter, the recipient may disenroll in that plan for any reason
6-21 and enroll in another managed care plan under this chapter.
6-22 (c) The commission shall allow a recipient who is enrolled
6-23 in a managed care plan under this chapter to disenroll in that plan
6-24 at any time for cause in accordance with federal law.
6-25 SECTION 7. If before implementing any provision of this Act
6-26 a state agency determines that a waiver or authorization from a
7-1 federal agency is necessary for implementation, the state agency
7-2 shall request the waiver or authorization and may delay
7-3 implementing that provision until the waiver or authorization is
7-4 granted.
7-5 SECTION 8. (a) Notwithstanding Section 32.0261, Human
7-6 Resources Code, as added by this Act, the Health and Human Services
7-7 Commission or the appropriate state agency operating part of the
7-8 medical assistance program under Chapter 32, Human Resources Code,
7-9 shall adopt rules in accordance with 42 U.S.C. Section
7-10 1396a(e)(12), as amended, to provide for a period of continuous
7-11 eligibility for a child under 19 years of age who is determined to
7-12 be eligible for medical assistance under that chapter. The rules
7-13 shall provide that the child remains eligible for medical
7-14 assistance, without additional review by the agency and regardless
7-15 of changes in the child's resources or income, until the earlier
7-16 of:
7-17 (1) the 180th day after the date on which the child's
7-18 eligibility was determined; or
7-19 (2) the child's 19th birthday.
7-20 (b) The Health and Human Services Commission or the
7-21 appropriate state agency operating part of the medical assistance
7-22 program under Chapter 32, Human Resources Code, shall adopt rules
7-23 required by this section not later than February 1, 2002. The
7-24 rules must provide for a six-month period of continuous eligibility
7-25 in accordance with this section for a child whose initial or
7-26 continued eligibility is determined on or after the effective date
8-1 of the rules. The rules adopted under this subsection remain in
8-2 effect until superseded by the rules adopted under Section 32.0261,
8-3 Human Resources Code, as added by this Act.
8-4 (c) This section expires on the date that the rules adopted
8-5 under Section 32.0261, Human Resources Code, as added by this Act,
8-6 take effect.
8-7 SECTION 9. (a) The Medicaid legislative oversight committee
8-8 created under S.B. No. 1156, 77th Legislature, Regular Session,
8-9 2001, may review and make recommendations regarding legislation
8-10 necessary to accomplish the purposes of Sections 32.025 and 32.026,
8-11 Human Resources Code, as amended by this Act, and Section 32.0261,
8-12 Human Resources Code, as added by this Act.
8-13 (b) Subsection (a) of this section takes effect only if S.B.
8-14 No. 1156, 77th Legislature, Regular Session, 2001, authorizes the
8-15 creation of the Medicaid legislative oversight committee and is
8-16 enacted and becomes law. If S.B. No. 1156 does not authorize the
8-17 creation of the committee, is not enacted, or does not become law,
8-18 this section has no effect.
8-19 SECTION 10. (a) Except as otherwise provided by this Act,
8-20 this Act takes effect January 1, 2002.
8-21 (b) Section 32.0261, Human Resources Code, as added by this
8-22 Act, takes effect September 1, 2002, but the appropriate state
8-23 agency may not implement the 12-month period of continuous
8-24 eligibility prescribed by that section until the date on which the
8-25 rules adopted under Subsection (c) of this section take effect.
8-26 (c) The Health and Human Services Commission or the
9-1 appropriate state agency operating part of the medical assistance
9-2 program under Chapter 32, Human Resources Code, shall adopt rules
9-3 required by Section 32.0261, Human Resources Code, as added by this
9-4 Act, so that the rules take effect in accordance with that section
9-5 not earlier than September 1, 2002, or later than June 1, 2003.
9-6 The rules must provide for a 12-month period of continuous
9-7 eligibility in accordance with that section for a child whose
9-8 initial or continued eligibility is determined on or after the
9-9 effective date of the rules.
9-10 (d) The Health and Human Services Commission or the
9-11 appropriate agency operating part of the medical assistance program
9-12 under Chapter 32, Human Resources Code, shall adopt rules required
9-13 by Section 32.0262, Human Resources Code, as added by this Act, not
9-14 later than February 1, 2002.
S.B. No. 43
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 43 passed the Senate on
April 18, 2001, by a viva-voce vote; and that the Senate concurred
in House amendments on May 27, 2001, by a viva-voce vote.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 43 passed the House, with
amendments, on May 21, 2001, by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor