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A BILL TO BE ENTITLED
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AN ACT
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relating to tailored benefit packages for certain categories of the |
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Medicaid population. |
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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 531.097 to read as follows: |
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Sec. 531.097. TAILORED BENEFIT PACKAGES FOR CERTAIN |
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CATEGORIES OF THE MEDICAID POPULATION. (a) If the commission |
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determines it is cost-effective, the commission shall seek a waiver |
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under Section 1115 of the federal Social Security Act (42 U.S.C. |
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Section 1315) to develop and implement tailored benefit packages |
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designed to: |
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(1) provide Medicaid benefits that are customized to |
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meet the health care needs of recipients within defined categories |
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of the Medicaid population; |
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(2) improve health outcomes for those recipients; |
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(3) improve those recipients' access to services; and |
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(4) achieve cost savings and efficiency. |
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(b) Each tailored benefit package developed under this |
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section must include: |
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(1) a basic set of benefits that are provided under all |
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tailored benefit packages; |
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(2) a set of benefits customized to meet the health |
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care needs of recipients in the defined category of the Medicaid |
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population to which the package applies; and |
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(3) to the extent feasible, services to integrate the |
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management of a recipient's acute and long-term care needs. |
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(c) A tailored benefit package developed under this section |
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may include any service available under the state Medicaid plan or |
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under any federal Medicaid waiver, including any preventive health |
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or wellness service. |
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(d) The executive commissioner, by rule, shall define each |
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category of recipients to which a tailored benefit package applies |
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and a mechanism for appropriately placing recipients in specific |
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categories. Recipient populations to which a package applies may |
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include: |
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(1) persons with disabilities or special health needs; |
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(2) elderly persons; |
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(3) children; and |
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(4) working-age parents and caretaker relatives. |
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(e) The commission may make a payment for a service provided |
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under a tailored benefit package developed under this section only |
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if the service is medically necessary and provided in accordance |
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with state and federal law. |
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(f) A tailored benefit package developed under this section |
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shall increase state flexibility in its use of Medicaid funding, |
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and not reduce state plan benefits for any Medicaid recipient |
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population. |
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(g) The commission shall offer the Early Periodic |
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Screening, Diagnosis, and Treatment (EPSDT) services as required by |
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federal law. |
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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. |