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By:  Zaffirini                                                    S.B. No. 1743
	(In the Senate - Filed March 14, 2003; March 24, 2003, read 
first time and referred to Committee on Health and Human Services; 
May 2, 2003, reported favorably by the following vote:  Yeas 8, 
Nays 0; May 2, 2003, sent to printer.)


A BILL TO BE ENTITLED

AN ACT


relating to medical assistance in certain alternative 
community-based care settings.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter B, Chapter 32, Human Resources Code, 
is amended by adding Section 32.057 to read as follows:
	Sec. 32.057.  LIMITATION ON MEDICAL ASSISTANCE IN CERTAIN 
ALTERNATIVE COMMUNITY-BASED CARE SETTINGS.  (a)  In this section:
		(1)  "Institution" means a nursing facility or an 
ICF-MR facility.   
		(2)  "Medical assistance waiver program" means:                        
			(A)  the community-based alternatives program;                        
			(B)  the community living assistance and support 
services program;  
			(C)  the deaf-blind/multiple disabilities 
program;                  
			(D)  the consolidated waiver pilot program; or                        
			(E)  the medically dependent children program.                        
	(b)  Except as provided by Subsection (c) or (d), the 
department may not provide services under a medical assistance 
waiver program to a person receiving medical assistance if the cost 
of providing those services exceeds the individual cost limit 
specified in the medical assistance waiver program.
	(c)  The department shall continue to provide services under 
a medical assistance waiver program to a person eligible for and 
receiving those services on September 1, 2003, if continuation of 
those services:
		(1)  is necessary for the person to live in the most 
integrated setting appropriate to the needs of the person; and
		(2)  does not affect the department's compliance with 
the federal cost-effectiveness and efficiency requirements of the 
medical assistance waiver program under 42 U.S.C. Sections 1396n(b) 
and (c)(2)(D), as amended.
	(d)  The department may continue to provide services under a 
medical assistance waiver program to a person who is ineligible to 
receive those services under Subsection (b) and to whom Subsection 
(c) does not apply if:
		(1)  the cost of providing those services to the person 
under the medical assistance waiver program does not exceed 133.3 
percent of the individual cost limit specified in the medical 
assistance waiver program; and
		(2)  continuation of those services does not affect the 
department's compliance with the federal cost-effectiveness and 
efficiency requirements of the medical assistance waiver program 
under 42 U.S.C. Sections 1396n(b) and (c)(2)(D), as amended.
	(e)  The Texas Board of Human Services or the Commissioner of 
Human Services may exempt a person from the cost limit established 
under Subsection (d)(1) if the Texas Board of Human Services or 
Commissioner of Human Services finds an undue hardship to the 
person in providing comparable services at the appropriate 
institution.
	SECTION 2.  This Act takes effect September 1, 2003, and 
applies to a person receiving medical assistance on or after that 
date, regardless of when eligibility for that assistance was 
determined.



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