79R3790 CLG-D

By:  Naishtat                                                     H.B. No. 1866



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 32.058 to read as follows:
	Sec. 32.058.  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 waiver services on September 1, 2005, if continuation of 
the waiver 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 1396n(c)(2)(D), as amended.
	(d)  The department may continue to provide services under a 
medical assistance waiver program to a person who becomes 
ineligible to receive waiver services under Subsection (b) and to 
whom Subsection (c) does not apply if:
		(1)  the cost of providing services to the person under 
the medical assistance waiver program does not exceed 133.3 percent 
of the amount that would have been paid for that person to receive 
comparable services in an institution over a 12-month period; and
		(2)  continuation of the waiver 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 
1396n(c)(2)(D), as amended.
	(e)  The executive commissioner of the Health and Human 
Services Commission may adopt rules under which the department may 
exempt a person from the cost limit established under Subsection 
(d)(1) if the department finds that providing comparable services 
at the appropriate institution would impose an undue hardship on 
the person.
	SECTION 2.  This Act applies to a person receiving medical 
assistance on or after the effective date of this Act, regardless of 
when eligibility for that assistance was determined.
	SECTION 3.  This Act takes effect September 1, 2005.