| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to requiring cost sharing for certain high-cost Medicaid |
|
|
services. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
|
|
is amended by adding Section 32.0641 to read as follows: |
|
|
Sec. 32.0641. COST SHARING FOR CERTAIN HIGH-COST MEDICAL |
|
|
SERVICES. If the department determines that it is feasible and |
|
|
cost-effective, and to the extent permitted under Title XIX, Social |
|
|
Security Act (42 U.S.C. Section 1396 et seq.) and any other |
|
|
applicable law or regulation, the executive commissioner of the |
|
|
Health and Human Services Commission may adopt cost-sharing |
|
|
provisions that require a recipient who chooses a high-cost medical |
|
|
service provided through a hospital emergency room to pay a |
|
|
copayment or premium payment for the high-cost medical service if: |
|
|
(1) the hospital from which the recipient seeks |
|
|
service: |
|
|
(A) performs an appropriate medical screening |
|
|
and determines that the recipient does not have a condition |
|
|
requiring emergency medical services; |
|
|
(B) informs the recipient: |
|
|
(i) that the recipient does not have a |
|
|
condition requiring emergency medical services; |
|
|
(ii) that, if the hospital provides the |
|
|
nonemergency service, the hospital may require payment of a |
|
|
copayment, premium payment, or other cost-sharing payment by the |
|
|
recipient in advance; and |
|
|
(iii) of the name and address of a |
|
|
nonemergency Medicaid provider who can provide the appropriate |
|
|
medical service without imposing a cost-sharing payment; and |
|
|
(C) offers to provide the recipient with a |
|
|
referral to the nonemergency provider to facilitate scheduling of |
|
|
the service; and |
|
|
(2) after receiving the information and assistance |
|
|
described by Subdivision (1) from the hospital, the recipient |
|
|
chooses to obtain emergency medical services despite having access |
|
|
to medically acceptable, lower-cost medical services. |
|
|
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. |