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A BILL TO BE ENTITLED
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AN ACT
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relating to the requirements for uniform fair hearing rules for |
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Medicaid services, including services that require prior |
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authorization. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.024, Government Code, is amended to |
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read as follows: |
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Sec. 531.024. PLANNING AND DELIVERY OF HEALTH AND HUMAN |
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SERVICES. (a) The executive commissioner shall: |
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(1) facilitate and enforce coordinated planning and |
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delivery of health and human services, including: |
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(A) compliance with the coordinated strategic |
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plan; |
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(B) co-location of services; |
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(C) integrated intake; and |
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(D) coordinated referral and case management; |
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(2) develop with the Department of Information |
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Resources automation standards for computer systems to enable |
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health and human services agencies, including agencies operating at |
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a local level, to share pertinent data; |
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(3) establish and enforce uniform regional boundaries |
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for all health and human services agencies; |
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(4) carry out statewide health and human services |
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needs surveys and forecasting; |
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(5) perform independent special-outcome evaluations |
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of health and human services programs and activities; |
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(6) at the request of a governmental entity identified |
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under Section 531.022(e), assist that entity in implementing a |
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coordinated plan that may include co-location of services, |
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integrated intake, and coordinated referral and case management and |
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is tailored to the needs and priorities of that entity; and |
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(7) promulgate uniform fair hearing rules for all |
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Medicaid-funded services. |
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(b) The rules promulgated under Subsection (a)(7) must |
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provide due process to an applicant for Medicaid services and to a |
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Medicaid recipient who seeks a Medicaid service, including a |
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service that requires prior authorization. The rules must provide |
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the protections for applicants and recipients required by 42 C.F.R. |
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Part 431, Subpart E, including requiring that: |
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(1) the written notice to an individual of the |
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individual's right to a hearing must: |
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(A) contain an explanation of the circumstances |
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under which Medicaid is continued if a hearing is requested; and |
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(B) be mailed at least 10 days before the date the |
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individual's Medicaid eligibility or service is scheduled to be |
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terminated, suspended, or reduced, except as provided by 42 C.F.R. |
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Section 431.213 or 431.214; and |
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(2) if a hearing is requested before the date a |
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Medicaid recipient's service is scheduled to be terminated, |
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suspended, or reduced, the agency may not take that proposed action |
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before a decision is rendered after the hearing, except as provided |
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by Subsection (c). |
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(c) An agency may take the proposed action described by |
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Subsection (b)(2) before a decision is rendered after the hearing |
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only if it is determined at the hearing that: |
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(1) the sole issue is one of federal or state law or |
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policy, and the Medicaid recipient is promptly informed in writing |
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that services are to be terminated or reduced pending the hearing |
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decision; or |
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(2) the service the recipient seeks to continue |
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pending the hearing decision is an increased amount of the service |
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or is a service that requires prior authorization, and the service |
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was not authorized during the preceding prior authorization period. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2007. |