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By: Lindsay S.B. No. 1467
A BILL TO BE ENTITLED
AN ACT
relating to the enrollment of recipients of Supplemental Security
Income in certain medical assistance programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter C, Chapter 62, Health and Safety
Code, is amended by adding Section 62.106 to read as follows:
Sec. 62.106. RECIPIENTS OF SUPPLEMENTAL SECURITY INCOME.
(a) Within 21 days of receiving notice from the Social Security
Administration that a child enrolled in the state child health plan
is eligible for Supplemental Security Income, the commission shall:
(1) disenroll the child from the state child health
plan retroactive to the date the child became eligible for medical
assistance pursuant to Chapter 32 of the Human Resources Code, the
Social Security Act, and relevant federal regulations;
(2) submit to the child information to voluntarily
enroll in a medical assistance managed care plan; and
(3) reimburse a health plan provider for any payments
made by it to a health care provider for services delivered to the
child on and after the date the child became eligible for medical
assistance pursuant to Chapter 32 of the Human Resources Code, the
Social Security Act, and relevant federal regulations.
(b) To be eligible for reimbursement under Subsection (c), a
health plan provider must refund to the commission any capitation
payments received to provide health benefits coverage for the child
for a period on or after the date the child became eligible for
Supplemental Security Income (SSI).
SECTION 2. Section 533.0076, Government Code, is amended by
adding Subsection (d) to read as follows:
(d) This section does not prohibit the commission from
disenrolling a recipient under Section 533.0077.
SECTION 3. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0077 to read as follows:
Sec. 533.0077. RECIPIENTS OF SUPPLEMENTAL SECURITY INCOME.
(a) Except as provided for under Subsection (b) and (c), within 21
days of receiving notice from the Social Security Administration
that a recipient enrolled in a managed care plan is eligible for
Supplemental Security Income, the Commission shall:
(1) disenroll the recipient from the managed care plan
retroactive to the date the recipient became eligible for
Supplemental Security Income as identified by the Social Security
Administration;
(2) provide to the child's parent or guardian
information about enrolling in the medical assistance program under
Chapter 32, Human Resources Code, or voluntarily enrolling in an
appropriate medical assistance managed care program as available in
the child's health care service region; and
(3) reimburse a managed care organization for any
payments made by it to a health care provider for services delivered
to the recipient on and after the date the recipient became eligible
for Supplemental Security Income as determined by the Social
Security Administration.
(b) Subsection (a) does not apply to a medical assistance
managed care program designed primarily to provide behavioral
health services separate and apart from other medical services and
implemented with one or more federal waivers.
(c) This Subsection applies to any area of the state in
which one or more federal waivers require a recipient who is
receiving Supplemental Security Income to enroll in a managed care
plan for comprehensive medical services and long-term care
services. Within 21 days of receiving notice from the Social
Security Administration that a recipient enrolled in a managed care
plan has become eligible for Supplemental Security Income, the
Commission shall:
(1) disenroll the recipient from the managed care
organization that is participating in a medical assistance project
that does not mandate participation of recipients of Supplemental
Security Income, retroactive to the date the recipient became
eligible for Supplemental Security Income as identified by the
Social Security Administration, to the traditional Medicaid
program;
(2) prospectively enroll, using the established
Medicaid managed care enrollment procedures, the recipient in a
managed care plan that has been designated by the Commission in a
federal waiver to provide covered services to recipients of
Supplemental Security Income as identified by the Social Security
Administration; and
(3) reimburse the managed care organization
identified in subpart (1) for any payments made by it to a health
care provider for services delivered to the recipient on and after
the date the recipient became eligible for Supplemental Security
Income as identified by the Social Security Administration.
(d) To be eligible for reimbursement under Subsection
(a)(3) or (c)(3), a managed care organization must refund to the
commission any capitation payments received to provide health
benefits coverage for the recipient for a period on or after the
date the recipient became eligible for Supplemental Security Income
(SSI), as determined by the Social Security Administration.
SECTION 4. It is the understanding of the Legislature that
the current waivers in place with federal government already
provide for the provisions of this Act; therefore, it is the
Legislature's understanding that no waivers or authorizations from
the federal government should be necessary to implement this Act,
that no appropriations are necessary to implement this act, and
that no changes in capitation rates paid to any managed care
organization are necessary to implement this act. However, within
30 days of the effective date of this Act, an agency affected by any
provision of the Act shall determine:
a. whether a waiver or authorization from a federal
agency is necessary for implementation of any provision of this
Act; or
b. whether capitation payment rates paid to any
affected organizations must be amended to implement this Act.
If such a determination is made, the affected agency shall
promulgate rules within 180 days of the effective date of this Act
regarding any such waiver, authorization, or change to capitation
payment rates prior to seeking such a waiver, authorization or
making any such change to capitation payment rates. Following the
final adoption of any such rules, the state agency shall seek such a
waiver or authorization from a federal agency. Implementation of
this Act may be delayed pending receipt of a waiver or authorization
from a federal agency.
SECTION 5. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2001.