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A BILL TO BE ENTITLED
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AN ACT
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relating to an exemption from cost limits specified for certain |
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medical assistance waiver programs administered by the Department |
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of Aging and Disability Services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 32.058, Human Resources Code, is amended |
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to read as follows: |
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Sec. 32.058. LIMITATION ON MEDICAL ASSISTANCE IN CERTAIN |
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ALTERNATIVE COMMUNITY-BASED CARE SETTINGS. (a) In this section, |
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"medical assistance waiver program" means a program, other than the |
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Texas home living program, that provides home or community-based |
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services under a waiver granted in accordance with 42 U.S.C. |
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Section 1396n(c)[:
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[(1) "Institution" means a nursing facility or an
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ICF-MR facility.
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[(2)"Medical assistance waiver program" means:
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[(A)the community-based alternatives program;
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[(B) the community living assistance and support
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services program;
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[(C) the deaf-blind/multiple disabilities
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program;
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[(D)the consolidated waiver pilot program; or
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[(E)the medically dependent children program]. |
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(b) Except as provided by Subsection (c), [or] (d), (e), or |
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(f), the department may not provide services under a medical |
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assistance waiver program to a person [receiving medical
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assistance] if the cost of providing those services over a 12-month |
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period exceeds the individual cost limit specified in the medical |
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assistance waiver program. |
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(c) The department shall continue to provide services under |
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a medical assistance waiver program to a person who was [is] |
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receiving those services on September 1, 2005, at a cost over a |
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12-month period that exceeds the individual cost limit specified in |
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the medical assistance waiver program, if continuation of those |
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services: |
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(1) is necessary for the person to live in the most |
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integrated setting appropriate to the needs of the person; and |
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(2) does not affect the department's compliance with |
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the federal average per capita expenditure requirement |
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[cost-effectiveness and efficiency requirements] of the medical |
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assistance waiver program under 42 U.S.C. Section [Sections
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1396n(b) and] 1396n(c)(2)(D). |
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(d) The department may continue to provide services under a |
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medical assistance waiver program, other than the home and |
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community-based services program, to a person who is ineligible to |
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receive those services under Subsection (b) and to whom Subsection |
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(c) does not apply if: |
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(1) the cost of providing those services to the person |
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under the medical assistance waiver program over a 12-month period |
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does not exceed 133.3 percent of the individual cost limit |
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specified in the medical assistance waiver program; and |
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(2) continuation of those services does not affect the |
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department's compliance with the federal average per capita |
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expenditure requirement [cost-effectiveness and efficiency
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requirements] of the medical assistance waiver program under 42 |
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U.S.C. Section [Sections 1396n(b) and] 1396n(c)(2)(D). |
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(e) The department may exempt a person from the cost limit |
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established under Subsection (d)(1) for a medical assistance waiver |
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program if the department determines that: |
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(1) the person's health and safety cannot be protected |
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by the services provided within the cost limit established for the |
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program under that subdivision; and |
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(2) there is no available living arrangement, other |
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than one provided through the program or another medical assistance |
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waiver program, in which the person's health and safety can be |
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protected, as evidenced by: |
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(A) an assessment conducted by clinical staff of |
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the department; and |
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(B) supporting documentation, including the |
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person's medical and service records. |
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(f) The department may continue to provide services under |
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the home and community-based services program to a person who is |
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ineligible to receive those services under Subsection (b) and to |
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whom Subsection (c) does not apply if the department makes, with |
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regard to the person's receipt of services under the home and |
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community-based services program, the same determinations required |
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by Subsections (e)(1) and (2) in the same manner provided by |
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Subsection (e) and determines that continuation of those services |
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does not affect: |
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(1) the department's compliance with the federal |
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average per capita expenditure requirement of the home and |
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community-based services program under 42 U.S.C. Section |
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1396n(c)(2)(D); and |
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(2) any cost-effectiveness requirements provided by |
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the General Appropriations Act that limit expenditures for the home |
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and community-based services program. |
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(g) The executive commissioner of the Health and Human |
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Services Commission may adopt rules to implement Subsections (e) |
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and (f) [under which the department may exempt a person from the
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cost limit established under Subsection (d)(1)]. |
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SECTION 2. The changes in law made by this Act apply only to |
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a person receiving medical assistance on or after the effective |
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date of this Act, regardless of when eligibility for that |
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assistance was determined. |
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SECTION 3. This Act takes effect September 1, 2007. |