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A BILL TO BE ENTITLED
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AN ACT
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relating to eligibility determinations for the STAR+PLUS home and |
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community based services (HCBS) program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.00282 to read as follows: |
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Sec. 533.00282. ELIGIBILITY DETERMINATIONS FOR STAR+PLUS |
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HOME AND COMMUNITY BASED SERVICES (HCBS) PROGRAM. (a) The |
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commission shall determine Medicaid eligibility for an applicant |
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for the STAR+PLUS home and community based services (HCBS) program |
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not later than: |
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(1) the 20th day after the date the applicant submits |
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the application; or |
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(2) the 45th day after the date the applicant submits |
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the application, if the applicant is applying on the basis of a |
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disability. |
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(b) A managed care organization with which the commission |
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contracts to provide health care services to recipients shall, not |
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later than the 30th day after the date an applicant for the |
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STAR+PLUS home and community based services (HCBS) program submits |
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the application, complete and submit to the entity serving as this |
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state's Medicaid claims administrator the applicant's: |
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(1) individual service plan; and |
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(2) medical necessity and level of care assessment. |
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SECTION 2. Section 533.00282(a), Government Code, as added |
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by this Act, applies only to an application for a determination of |
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Medicaid eligibility submitted on or after the effective date of |
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this Act. An application for a determination of Medicaid |
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eligibility submitted before the effective date of this Act is |
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governed by the law in effect immediately before the effective date |
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of this Act, and that law is continued in effect for that purpose. |
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SECTION 3. (a) The Health and Human Services Commission |
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shall, in a contract between the commission and a managed care |
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organization under Chapter 533, Government Code, that is entered |
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into or renewed on or after the effective date of this Act, require |
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that the managed care organization comply with Section |
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533.00282(b), Government Code, as added by this Act. |
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(b) The Health and Human Services Commission shall seek to |
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amend contracts entered into with managed care organizations under |
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Chapter 533, Government Code, before the effective date of this Act |
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to require those managed care organizations to comply with Section |
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533.00282(b), Government Code, as added by this Act. To the extent |
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of a conflict between Section 533.00282(b), Government Code, as |
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added by this Act, and a provision of a contract with a managed care |
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organization entered into before the effective date of this Act, |
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the contract provision prevails. |
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SECTION 4. 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 5. This Act takes effect September 1, 2019. |