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A BILL TO BE ENTITLED
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AN ACT
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relating to implementing certain incentives and cost-sharing |
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requirements under the Medicaid program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.098 to read as follows: |
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Sec. 531.098. INCENTIVES TO PROMOTE HEALTHY BEHAVIORS. (a) |
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If the commission determines that it is feasible and |
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cost-effective, the commission shall develop and implement |
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incentives to encourage Medicaid recipients to engage in healthy |
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behaviors. |
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(b) Incentives implemented under Subsection (a) may include |
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enhanced benefit accounts, health opportunity accounts, health |
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savings accounts, or other similar rewards accounts that allow |
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Medicaid recipients who engage in prescribed health-related |
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activities to earn credits to the accounts that may be used to |
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obtain additional benefits. |
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(c) Incentives implemented under Subsection (a) shall |
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provide positive rewards for healthy behaviors, and not punitive |
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incentives. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.0641 to read as follows: |
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Sec. 32.0641. COST SHARING FOR CERTAIN HIGH-COST MEDICAL |
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SERVICES. To the extent permitted under federal law, the executive |
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commissioner of the Health and Human Services Commission may adopt |
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cost-sharing provisions that require a recipient who chooses a |
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high-cost medical service provided through a hospital emergency |
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room to pay a copayment or premium payment for the high-cost medical |
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service if: |
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(1) the hospital from which the recipient seeks |
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service: |
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(A) performs an appropriate medical screening |
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and determines that the recipient does not have a condition |
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requiring emergency medical services; |
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(B) informs the recipient: |
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(i) that the recipient does not have a |
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condition requiring emergency medical services; |
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(ii) that, if the hospital provides the |
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nonemergency service, the hospital may require payment of a |
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copayment, premium payment, or other cost-sharing payment by the |
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recipient in advance; and |
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(iii) of the name and address of a |
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nonemergency Medicaid provider who can provide the appropriate |
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medical service without imposing a cost-sharing payment; and |
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(C) offers to provide the recipient with a |
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referral to the nonemergency provider to facilitate scheduling of |
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the service; and |
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(2) after receiving the information and assistance |
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described by Subdivision (1) from the hospital, the recipient |
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chooses to obtain emergency medical services despite having access |
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to medically acceptable, lower-cost medical services. |
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SECTION 3. 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. Any waiver applied for under |
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this Act shall not be used to divert Medicaid recipients from |
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receiving emergency care for emergencies and shall not waive any |
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provision of the federal Emergency Medical Treatment and Active |
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Labor Act (42 U.S.C. Section 1395dd). |
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SECTION 4. This Act takes effect September 1, 2007. |