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A BILL TO BE ENTITLED
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AN ACT
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relating to requiring cost sharing for certain high-cost Medicaid |
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services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. 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. If the department determines that it is feasible and |
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cost-effective, and to the extent permitted under Title XIX, Social |
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Security Act (42 U.S.C. Section 1396 et seq.) and any other |
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applicable law or regulation, the executive commissioner of the |
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Health and Human Services Commission may adopt cost-sharing |
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provisions that require a recipient who chooses a high-cost medical |
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service provided through a hospital emergency room to pay a |
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copayment or premium payment for the high-cost medical 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 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. |