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.