Amend CSSB 10 (house committee printing) by adding the 
following appropriately numbered SECTION to the bill and 
renumbering subsequent SECTIONS of the bill accordingly:
	SECTION ____.  (a) Section 32.058, Human Resources Code, is 
amended to read as follows:
	Sec. 32.058.  LIMITATION ON MEDICAL ASSISTANCE IN CERTAIN 
ALTERNATIVE COMMUNITY-BASED CARE SETTINGS.  (a)  In this section, 
"medical assistance waiver program" means a program administered by 
the Department of Aging and Disability Services, other than the 
Texas home living program, that provides services under a waiver 
granted in accordance with 42 U.S.C. Section 1396n(c)[:
		[(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), (e), or 
(f), the department may not provide services under a medical 
assistance waiver program to a person [receiving medical 
assistance] if the projected cost of providing those services over 
a 12-month period 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 was [is] 
receiving those services on September 1, 2005, at a cost that 
exceeded [exceeds] the individual cost limit specified in the 
medical assistance waiver program, 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 average per capita expenditure requirement
[cost-effectiveness and efficiency requirements] of the medical 
assistance waiver program under 42 U.S.C. Section [Sections 
1396n(b) and] 1396n(c)(2)(D).
	(d)  The department may continue to provide services under a 
medical assistance waiver program, other than the home and 
community-based services 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 projected cost of providing those services to 
the person under the medical assistance waiver program over a 
12-month period 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 average per capita 
expenditure requirement [cost-effectiveness and efficiency 
requirements] of the medical assistance waiver program under 42 
U.S.C. Section [Sections 1396n(b) and] 1396n(c)(2)(D).
	(e)  The department may exempt a person from the cost limit 
established under Subsection (d)(1) for a medical assistance waiver 
program if the department determines that:
		(1)  the person's health and safety cannot be protected 
by the services provided within the cost limit established for the 
program under that subdivision; and
		(2)  there is no available living arrangement, other 
than one provided through the program or another medical assistance 
waiver program, in which the person's health and safety can be 
protected, as evidenced by:
			(A)  an assessment conducted by clinical staff of 
the department; and
			(B)  supporting documentation, including the 
person's medical and service records.
	(f)  The department may continue to provide services under 
the home and community-based services program to a person who is 
ineligible to receive those services under Subsection (b) and to 
whom Subsection (c) does not apply if the department makes, with 
regard to the person's receipt of services under the home and 
community-based services program, the same determinations required 
by Subsections (e)(1) and (2) in the same manner provided by 
Subsection (e) and determines that continuation of those services 
does not affect:
		(1)  the department's compliance with the federal 
average per capita expenditure requirement of the home and 
community-based services program under 42 U.S.C. Section 
1396n(c)(2)(D); and
		(2)  any cost-effectiveness requirements provided by 
the General Appropriations Act that limit expenditures for the home 
and community-based services program.
	(g)  The executive commissioner of the Health and Human 
Services Commission may adopt rules to implement Subsections (d), 
(e), and (f) [under which the department may exempt a person from 
the cost limit established under Subsection (d)(1)].
	(h)  If a federal agency determines that compliance with any 
provision in this section would make this state ineligible to 
receive federal funds to administer a program to which this section 
applies, a state agency may, but is not required to, implement that 
provision.
	(b)  The changes in law made by this section apply only to a 
person receiving medical assistance on or after the effective date 
of this section, regardless of when eligibility for that assistance 
was determined.