By: McReynolds (Senate Sponsor - Deuell) H.B. No. 2256
         (In the Senate - Received from the House May 14, 2007;
  May 15, 2007, read first time and referred to Committee on Health
  and Human Services; May 18, 2007, reported favorably by the
  following vote:  Yeas 7, Nays 0; May 18, 2007, sent to printer.)
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to the requirements for uniform fair hearing rules for
  Medicaid services, including services that require prior
  authorization.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.024, Government Code, is amended to
  read as follows:
         Sec. 531.024.  PLANNING AND DELIVERY OF HEALTH AND HUMAN
  SERVICES.  (a)  The executive commissioner shall:
               (1)  facilitate and enforce coordinated planning and
  delivery of health and human services, including:
                     (A)  compliance with the coordinated strategic
  plan;
                     (B)  co-location of services;
                     (C)  integrated intake; and
                     (D)  coordinated referral and case management;
               (2)  develop with the Department of Information
  Resources automation standards for computer systems to enable
  health and human services agencies, including agencies operating at
  a local level, to share pertinent data;
               (3)  establish and enforce uniform regional boundaries
  for all health and human services agencies;
               (4)  carry out statewide health and human services
  needs surveys and forecasting;
               (5)  perform independent special-outcome evaluations
  of health and human services programs and activities;
               (6)  at the request of a governmental entity identified
  under Section 531.022(e), assist that entity in implementing a
  coordinated plan that may include co-location of services,
  integrated intake, and coordinated referral and case management and
  is tailored to the needs and priorities of that entity; and
               (7)  promulgate uniform fair hearing rules for all
  Medicaid-funded services.
         (b)  The rules promulgated under Subsection (a)(7) must
  provide due process to an applicant for Medicaid services and to a
  Medicaid recipient who seeks a Medicaid service, including a
  service that requires prior authorization. The rules must provide
  the protections for applicants and recipients required by 42 C.F.R.
  Part 431, Subpart E, including requiring that:
               (1)  the written notice to an individual of the
  individual's right to a hearing must:
                     (A)  contain an explanation of the circumstances
  under which Medicaid is continued if a hearing is requested; and
                     (B)  be mailed at least 10 days before the date the
  individual's Medicaid eligibility or service is scheduled to be
  terminated, suspended, or reduced, except as provided by 42 C.F.R.
  Section 431.213 or 431.214; and
               (2)  if a hearing is requested before the date a
  Medicaid recipient's service, including a service that requires
  prior authorization, is scheduled to be terminated, suspended, or
  reduced, the agency may not take that proposed action before a
  decision is rendered after the hearing unless:
                     (A)  it is determined at the hearing that the sole
  issue is one of federal or state law or policy; and
                     (B)  the agency promptly informs the recipient in
  writing that services are to be terminated, suspended, or reduced
  pending the hearing decision.
         SECTION 2.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 3.  This Act takes effect September 1, 2007.
 
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