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A BILL TO BE ENTITLED
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AN ACT
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relating to a person's eligibility for Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 32.026, Human Resources Code, is amended |
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by adding Subsection (a-1) to read as follows: |
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(a-1) Rules adopted under Subsection (a) must require that: |
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(1) a person applying for medical assistance or having |
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the person's eligibility for medical assistance recertified |
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provide the commission with proof of: |
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(A) at least one month's income from all sources |
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received; and |
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(B) residency in this state; |
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(2) the commission provide a recipient notice of the |
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requirements for continued eligibility at least 60 days before the |
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date the recipient's eligibility for medical assistance will expire |
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with a warning that if the recipient fails to fulfill the |
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requirements, the recipient's eligibility for medical assistance |
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will cease on the last day of the eligibility period; |
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(3) a recipient's eligibility may be reinstated |
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without requiring a new application if the recipient fulfills the |
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requirements for continued eligibility before the last day of the |
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month following the last day of the eligibility period; and |
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(4) a recipient whose medical assistance has expired |
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may reapply for medical assistance at any time. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.02615 to read as follows: |
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Sec. 32.02615. ELIGIBILITY VERIFICATION VENDOR. (a) The |
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executive commissioner shall contract with a private vendor to, |
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using random sampling procedures, conduct an annual audit of |
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recipients enrolled in the medical assistance program to verify |
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that recipients are eligible for assistance under the program. In |
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conducting an audit under this section, the private vendor shall: |
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(1) perform data matches using the name, date of |
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birth, address, and social security number of each recipient |
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against public records to verify recipient eligibility; and |
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(2) make and submit to the commission a preliminary |
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determination regarding whether a recipient is eligible or is not |
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eligible for benefits under the medical assistance program. |
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(b) Not later than the 20th day after the date the |
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commission receives a preliminary determination under Subsection |
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(a)(2), the commission shall accept or reject the private vendor's |
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determination and provide the private vendor with notice of the |
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commission's decision respecting the private vendor's |
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determination together with the commission's stated reason for any |
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rejection of the private vendor's determination. |
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(c) The private vendor shall keep a record of all |
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preliminary determinations of ineligibility for medical assistance |
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communicated to the commission under this section. |
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(d) Not later than the 30th day following the end of each |
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calendar quarter, the commission and the private vendor shall |
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submit a joint report on audits conducted and actions taken during |
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the preceding calendar quarter under this section to the governor, |
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lieutenant governor, and speaker of the house of representatives. |
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The report must include: |
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(1) the number of preliminary determinations of |
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eligibility or ineligibility submitted to the commission by the |
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private vendor under Subsection (a)(2), reported on a monthly |
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basis; and |
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(2) the commission's actions taken with respect to the |
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determinations made by the private vendor and the commission's |
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stated reasons for rejecting any determination of ineligibility |
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made by the private vendor. |
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(e) Information shared with a private vendor under this |
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section is confidential. The private vendor may use the |
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information only for the purposes authorized under this section. |
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The contract between the commission and the private vendor may |
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include penalties for the unauthorized use of the information. |
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(f) The executive commissioner shall adopt rules necessary |
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to implement this section, including rules: |
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(1) establishing minimum qualifications for a private |
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vendor selected to perform audits under this section; and |
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(2) exempting appropriate categories of recipients |
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from audit which may include recipients whose eligibility for |
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medical assistance benefits was verified within the three-month |
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period preceding an audit. |
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(g) This section does not affect the commission's authority |
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to finally determine a recipient's eligibility for benefits under |
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the medical assistance program. |
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SECTION 3. As soon as practicable after the effective date |
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of this Act but not later than December 31, 2017, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt the rules required by Section 32.026, Human Resources Code, |
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as amended by this Act. |
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SECTION 4. Section 32.026, Human Resources Code, as amended |
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by this Act, applies to an initial determination or redetermination |
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of eligibility of a person for medical assistance under Chapter 32, |
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Human Resources Code, that is made on or after January 1, 2018. |
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SECTION 5. The initial contract entered into under Section |
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32.02615, Human Resources Code, as added by this Act, may not exceed |
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a term of two years and may only be renewed or extended for two |
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successive one-year periods. |
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SECTION 6. 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 7. This Act takes effect September 1, 2017. |