By: Ellis S.B. No. 1654

A BILL TO BE ENTITLED

AN ACT

relating to the enrollment of recipients of Supplemental Security Income in certain medical assistance programs.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter C, Chapter 62, Health and Safety Code, is amended by adding Section 62.106 to read as follows:

Sec. 62.106. RECIPIENTS OF SUPPLEMENTAL SECURITY INCOME. (a) Within 21 days of receiving notice from the Social Security Administration that a child enrolled in the state child health plan is eligible for Supplemental Security Income, the commission shall:

(1) disenroll the child from the state child health plan retroactive to the date the child became eligible for medical assistance pursuant to Chapter 32 of the Human Resources Code, the Social Security Act, and relevant federal regulations;

(2) submit to the child information to voluntarily enroll in a medical assistance managed care plan; and

(3) reimburse a health plan provider for any payments made by it to a health care provider for services delivered to the child on and after the date the child became eligible for medical assistance pursuant to Chapter 32 of the Human Resources Code, the Social Security Act, and relevant federal regulations.

(b) To be eligible for reimbursement under Subsection (c), a health plan provider must refund to the commission any capitation payments received to provide health benefits coverage for the child for a period on or after the date the child became eligible for Supplemental Security Income (SSI).

SECTION 2. Section 533.0076, Government Code, is amended by adding Subsection (d) to read as follows:

(d) This section does not prohibit the commission from disenrolling a recipient under Section 533.0077.

SECTION 3. Subchapter A, Chapter 533, Government Code, is amended by adding Section 533.0077 to read as follows:

Sec. 533.0077. RECIPIENTS OF SUPPLEMENTAL SECURITY INCOME. (a) Except as provided for under Subsection (b) and (c), within 21 days of receiving notice from the Social Security Administration that a recipient enrolled in a managed care plan is eligible for Supplemental Security Income, the Commission shall:

(1) disenroll the recipient from the managed care plan retroactive to the date the recipient became eligible for Supplemental Security Income as identified by the Social Security Administration;

(2) provide to the child's parent or guardian information about enrolling in the medical assistance program under Chapter 32, Human Resources Code, or voluntarily enrolling in an appropriate medical assistance managed care program as available in the child's health care service region; and

(3) reimburse a managed care organization for any payments made by it to a health care provider for services delivered to the recipient on and after the date the recipient became eligible for Supplemental Security Income as determined by the Social Security Administration.

(b) Subsection (a) does not apply to a medical assistance managed care program designed primarily to provide behavioral health services separate and apart from other medical services and implemented with one or more federal waivers.

(c) This Subsection applies to any area of the state in which one or more federal waivers require a recipient who is receiving Supplemental Security Income to enroll in a managed care plan for comprehensive medical services and long-term care services. Within 21 days of receiving notice from the Social Security Administration that a recipient enrolled in a managed care plan has become eligible for Supplemental Security Income, the Commission shall:

(1) disenroll the recipient from the managed care organization that is participating in a medical assistance project that does not mandate participation of recipients of Supplemental Security Income, retroactive to the date the recipient became eligible for Supplemental Security Income as identified by the Social Security Administration, to the traditional Medicaid program;

(2) prospectively enroll, using the established Medicaid managed care enrollment procedures, the recipient in a managed care plan that has been designated by the Commission in a federal waiver to provide covered services to recipients of Supplemental Security Income as identified by the Social Security Administration; and

(3) reimburse the managed care organization identified in subpart (1) for any payments made by it to a health care provider for services delivered to the recipient on and after the date the recipient became eligible for Supplemental Security Income as identified by the Social Security Administration.

(d) To be eligible for reimbursement under Subsection (a)(3) or (c)(3), a managed care organization must refund to the commission any capitation payments received to provide health benefits coverage for the recipient for a period on or after the date the recipient became eligible for Supplemental Security Income (SSI), as determined by the Social Security Administration.

SECTION 4. It is the understanding of the Legislature that the current waivers in place with federal government already provide for the provisions of this Act; therefore, it is the Legislature's understanding that no waivers or authorizations from the federal government should be necessary to implement this Act, that no appropriations are necessary to implement this act, and that no changes in capitation rates paid to any managed care organization are necessary to implement this act. However, within 30 days of the effective date of this Act, an agency affected by any provision of the Act shall determine:

a. whether a waiver or authorization from a federal agency is necessary for implementation of any provision of this Act; or

b. whether capitation payment rates paid to any affected organizations must be amended to implement this Act. If such a determination is made, the affected agency shall promulgate rules within 180 days of the effective date of this Act regarding any such waiver, authorization, or change to capitation payment rates prior to seeking such a waiver, authorization or making any such change to capitation payment rates. Following the final adoption of any such rules, the state agency shall seek such a waiver or authorization from a federal agency. Implementation of this Act may be delayed pending receipt of a waiver or authorization from a federal agency.

SECTION 5. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2007.