By:  Zaffirini                                                    S.B. No. 626


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 who is receiving 
those services on September 1, 2005, at a cost that exceeds the 
individual cost limit specified in the medical assistance waiver, 
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 1396n(c)(2)(D).
	(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 1396n(c)(2)(D).
	(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).
	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.