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A BILL TO BE ENTITLED
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AN ACT
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relating to interest lists and eligibility criteria for certain |
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Medicaid waiver programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Sections 531.06011 and 531.06035 to read as |
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follows: |
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Sec. 531.06011. CERTAIN MEDICAID WAIVER PROGRAMS: INTEREST |
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LIST MANAGEMENT. (a) This section applies only with respect to the |
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following waiver programs: |
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(1) the community living assistance and support |
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services (CLASS) waiver program; |
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(2) the home and community-based services (HCS) waiver |
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program; |
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(3) the deaf-blind with multiple disabilities (DBMD) |
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waiver program; |
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(4) the Texas home living (TxHmL) waiver program; |
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(5) the medically dependent children (MDCP) waiver |
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program; and |
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(6) the STAR+PLUS home and community-based services |
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(HCBS) program. |
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(b) The commission, in consultation with the Intellectual |
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and Developmental Disability System Redesign Advisory Committee |
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established under Section 534.053, the state Medicaid managed care |
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advisory committee, and interested stakeholders, shall develop a |
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questionnaire to be completed by or on behalf of an individual who |
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requests to be placed on or is currently on an interest list for a |
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waiver program. |
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(c) The questionnaire developed under Subsection (b) must, |
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at a minimum, request the following information about an individual |
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seeking or receiving services under a waiver program: |
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(1) contact information for the individual or the |
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individual's parent or other legally authorized representative; |
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(2) the individual's general demographic information; |
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(3) the individual's living arrangement; |
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(4) the types of assistance the individual requires; |
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(5) the individual's current caregiver supports and |
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circumstances that may cause the individual to lose those supports; |
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and |
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(6) when the delivery of services under a waiver |
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program should begin to ensure the individual's health and welfare |
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and that the individual receives services and supports in the least |
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restrictive setting possible. |
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(d) Subject to the availability of funds, the commission |
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shall require all individuals on an interest list to annually |
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update the questionnaire developed under Subsection (b). |
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(e) If the commission determines that it is feasible, the |
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commission shall develop an online portal to allow an individual or |
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an individual's parent or other legally authorized representative |
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to: |
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(1) request placement on a waiver program interest |
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list; and |
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(2) complete and update the questionnaire developed |
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under Subsection (b). |
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(f) If an individual is on a waiver program's interest list |
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and the individual or the individual's parent or other legally |
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authorized representative does not respond to a written or verbal |
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request made by the commission to update information concerning the |
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individual or otherwise fails to maintain contact with the |
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commission, the commission: |
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(1) shall designate the individual's status on the |
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interest list as inactive until the individual or the individual's |
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parent or other legally authorized representative notifies the |
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commission that the individual is still interested in receiving |
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services under the waiver program; and |
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(2) at the time the individual or the individual's |
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parent or other legally authorized representative provides notice |
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to the commission under Subdivision (1), shall designate the |
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individual's status on the interest list as active and restore the |
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individual to the position on the list that corresponds with the |
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date the individual was initially placed on the list. |
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(g) The commission's designation of an individual's status |
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on an interest list as inactive under Subsection (f) may not result |
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in the removal of the individual from that list or any other waiver |
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program interest list. |
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(h) Not later than September 1 of each year, the commission |
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shall provide to the Intellectual and Developmental Disability |
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System Redesign Advisory Committee established under Section |
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534.053, or, if that advisory committee is abolished, an |
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appropriate stakeholder advisory committee, as determined by the |
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executive commissioner, the number of individuals, including |
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individuals whose status is designated as inactive by the |
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commission, who are on an interest list to receive services under a |
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waiver program. |
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Sec. 531.06035. MEDICALLY DEPENDENT CHILDREN WAIVER |
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PROGRAM (MDCP) INTEREST LIST; MEDICAL NECESSITY ASSESSMENT |
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REQUIRED. (a) This section applies only to a child who receives |
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Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et |
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seq.). |
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(b) If a child's parent or other legally authorized |
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representative expresses interest in placing the child on the |
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interest list for the medically dependent children (MDCP) waiver |
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program, the commission shall conduct a medical necessity |
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assessment of the child to ensure the child is eligible for services |
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before placing the child on the program's interest list. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.0521 to read as follows: |
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Sec. 32.0521. ELIGIBILITY FOR TEXAS HOME LIVING (TxHmL) |
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WAIVER PROGRAM. (a) In this section: |
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(1) "Related condition" means, consistent with 42 |
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C.F.R. Section 435.1010, a severe and chronic disability that: |
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(A) is attributed to: |
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(i) cerebral palsy or epilepsy; or |
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(ii) any other condition, other than mental |
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illness, found to be closely related to intellectual disability |
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because the condition results in impairment of general intellectual |
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functioning or adaptive behavior similar to that of individuals |
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with intellectual disability, and requires treatment or services |
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similar to those required for individuals with intellectual |
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disability; |
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(B) is manifested before the individual reaches |
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22 years of age; |
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(C) is likely to continue indefinitely; and |
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(D) results in substantial functional limitation |
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in at least three of the following areas of major life activity: |
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(i) self-care; |
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(ii) understanding and use of language; |
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(iii) learning; |
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(iv) mobility; |
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(v) self-direction; and |
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(vi) capacity for independent living. |
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(2) "Section 1915(c) waiver program" has the meaning |
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assigned by Section 531.001, Government Code. |
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(b) To the extent allowed by federal law, an individual is |
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financially eligible to participate in the Texas home living |
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(TxHmL) waiver program if the individual's income is not more than |
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the special income limit established by the commission for other |
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Section 1915(c) waiver programs, including the home and |
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community-based services (HCS) waiver program. |
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(c) To the extent permitted by federal law, the commission |
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shall expand medical eligibility criteria under the Texas home |
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living (TxHmL) waiver program to ensure that an individual is |
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medically eligible to participate in the waiver program if the |
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individual: |
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(1) has a primary diagnosis by a licensed physician of |
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a related condition that is included on the list of diagnostic codes |
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for persons with related conditions that are approved by the |
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commission; and |
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(2) has moderate to extreme deficits in adaptive |
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behavior, as determined by commission rule, obtained by |
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administering a standardized assessment of adaptive behavior. |
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SECTION 3. As soon as practicable after the effective date |
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of this Act, the Health and Human Services Commission shall: |
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(1) develop the questionnaire required by Section |
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531.06011(b), Government Code, as added by this Act, and, subject |
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to the availability of funds, implement Subsection (d) of that |
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section not later than September 1, 2024; |
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(2) determine the feasibility of developing an online |
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portal under Section 531.06011(e), Government Code, as added by |
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this Act, and if feasible, develop and implement the online portal; |
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and |
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(3) as appropriate, conduct a medical necessity |
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assessment of each child who is on the interest list for the |
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medically dependent children (MDCP) waiver program on the effective |
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date of this Act to ensure the child's eligibility for program |
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services. |
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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, 2021. |