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2005S0299-1 02/18/05
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;
(E) the medically dependent children program;
(F) the home and community-based waiver services
program; or
(G) the Texas home living waiver 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 exceeds the
individual cost limit in Subsection (b) and who is receiving those
services on September 1, 2005, 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) 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.