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A BILL TO BE ENTITLED
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AN ACT
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relating to the program of all-inclusive care for the elderly. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 32.053, Human Resources Code, is amended |
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by amending Subsections (b) and (e) and adding Subsections (b-1) |
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and (e-1) to read as follows: |
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(b) The executive commissioner shall adopt rules as |
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necessary to implement this section. In adopting rules, the |
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executive commissioner shall: |
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(1) use the Bienvivir Senior Health Services of El |
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Paso initiative as a model for the program; |
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(2) ensure that a person is not required to hold a |
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certificate of authority as a health maintenance organization under |
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Chapter 843, Insurance Code, to provide services under the PACE |
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program; |
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(3) ensure that participation in the PACE program is |
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available as an alternative to enrollment in a Medicaid managed |
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care plan under Chapter 533, Government Code, for eligible |
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recipients, including recipients eligible for assistance under |
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both the medical assistance and Medicare programs; |
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(4) ensure that the commission's enrollment broker |
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complies with the requirement under Subsection (b-1) to notify |
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recipients about the PACE program and refer those recipients, as |
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appropriate, to corresponding program sites; |
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(5) ensure that qualified eligible recipients who |
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choose to participate in the PACE program are allowed to enroll in |
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the program [managed care organizations that contract under Chapter |
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533, Government Code, consider the availability of the PACE program |
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when considering whether to refer a recipient to a nursing facility |
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or other long-term care facility]; |
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(6) [and |
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[(5)] establish protocols for the referral of eligible |
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persons to the PACE program; and |
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(7) ensure that the PACE enrollment census in existing |
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and future corresponding PACE program sites is allowed to grow |
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naturally based on need as determined by the enrollment census. |
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(b-1) The commission's enrollment broker shall: |
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(1) at the time a Medicaid recipient, including a |
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recipient enrolled in a managed care plan under Chapter 533, |
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Government Code, is determined eligible for nursing facility care, |
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if the recipient resides in a PACE program service area: |
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(A) notify the recipient that the recipient may: |
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(i) request an eligibility assessment to |
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participate in the PACE program; and |
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(ii) choose to enroll in the PACE program as |
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an alternative to enrolling in a managed care plan under Chapter |
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533, Government Code; and |
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(B) provide with the notification required by |
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Paragraph (A) educational materials described by Subsection (e-1); |
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and |
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(2) on a monthly basis and by electronic means, refer |
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each recipient described by Subdivision (1) to the PACE program |
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site in the corresponding service area. |
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(e) The commission [Department of Aging and Disability |
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Services] and area agencies on aging shall develop and implement a |
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coordinated plan to promote PACE program sites operating under this |
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section. The executive commissioner shall adopt policies and |
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procedures, including operating guidelines, to ensure that |
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caseworkers and any other appropriate department staff discuss the |
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benefits of participating in the PACE program with long-term care |
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clients. |
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(e-1) The commission shall develop educational materials |
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about the PACE program, including: |
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(1) the benefits of receiving acute care services and |
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long-term care services through the program; |
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(2) contact information for each program service area |
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site; and |
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(3) a statement that reads as follows: "YOU ARE |
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ELIGIBLE TO RECEIVE MEDICAL SERVICES IN OUR HOME THROUGH THE PACE |
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PROGRAM IN YOUR COMMUNITY. PLEASE CONTACT THE TELEPHONE NUMBER |
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BELOW: (telephone number)". |
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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, 2021. |