87R8496 KFF-F
 
  By: Guillen H.B. No. 3761
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the continuation of medical assistance for certain
  individuals.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 32.0256, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0256.  CONTINUATION OF MEDICAL ASSISTANCE FOR
  CERTAIN INDIVIDUALS; ANNUAL REPORT. (a) A recipient [described by
  Section 32.025(a)] who experiences an event or circumstance,
  including a temporary increase in income of a duration of one month
  or less or a minor technical or clerical error committed on or with
  respect to the recipient's renewal application or other document
  required for benefits renewal, that would normally result in the
  recipient being determined ineligible for medical assistance
  continues to be eligible for that assistance if the individual:
               (1)  either:
                     (A)  receives services through one of the
  following programs that serve [a program for] individuals with an
  intellectual or developmental disability [authorized] under
  Section 1915(c), Social Security Act (42 U.S.C. Section 1396n(c)):
                           (i)  the home and community-based services
  (HCS) waiver program; or
                           (ii)  the Texas home living (TxHmL) waiver
  program; or
                     (B)  resides in an ICF-IID facility; and
               (2)  continues to meet the functional and diagnostic
  criteria for the receipt of services under a program described by
  Subdivision (1)(A) or for residency in an ICF-IID facility.
         (b)  To continue to be eligible for medical assistance, a
  recipient described by Subsection (a) who is determined ineligible
  for medical assistance because of an event or circumstance caused
  wholly by the action or inaction of the recipient or the recipient's
  parent or guardian must submit an application for medical
  assistance in accordance with Section 32.025(b) not later than the
  90th day after the date on which the recipient is determined
  ineligible.
         (c)  The commission may not suspend or terminate the
  eligibility of a recipient for medical assistance benefits if the
  recipient's ineligibility is caused partly or wholly by a technical
  or clerical error committed by the commission or an agent of the
  commission.
         (d)  The commission shall:
               (1)  coordinate with and inform relevant health care
  providers if a recipient described by Subsection (a) is at risk of
  being determined ineligible for medical assistance benefits or is
  determined ineligible for those benefits; and
               (2)  make reasonable efforts to ensure the medical
  assistance benefits of a recipient described by Subsection (a) are
  not suspended or terminated.
         (e)  Not later than December 31 of each year, the commission
  shall prepare and submit a report to the legislature regarding the
  suspension or termination of medical assistance benefits of
  recipients described by Subsection (a) that occurred during the
  preceding state fiscal year. The report must include:
               (1)  the number of recipients who are living in a
  community-based, residential setting whose eligibility for
  benefits was suspended or terminated during each month of the
  fiscal year;
               (2)  if the commission reinstated the benefits of a
  recipient, the average, median, shortest, and longest length of
  time the commission took to reinstate those benefits;
               (3)  the number of recipients whose benefits were not
  reinstated by the commission;
               (4)  the specific reason for the suspension or
  termination of benefits of a recipient, including an analysis of
  the percentage of suspensions or terminations related to:
                     (A)  an increase in the recipient's income;
                     (B)  a failure by the recipient or the recipient's
  parent or guardian to properly submit a renewal application or
  other document required for benefits renewal;
                     (C)  a change in the recipient's condition that
  results in the recipient no longer meeting the functional or
  diagnostic criteria necessary to establish the recipient's
  eligibility for services under a program described by Subsection
  (a)(1)(A) or for residency in an ICF-IID facility;
                     (D)  a technical or clerical error committed by
  the commission or an agent of the commission; and
                     (E)  any other reason that occurs with enough
  frequency to warrant its inclusion in the analysis, as determined
  by the commission; and
               (5)  a statement of the amount of retroactive
  reimbursements paid to health care providers for the provision of
  services to a recipient during the time the recipient's eligibility
  for benefits was suspended or terminated.
         SECTION 2.  Section 3, Chapter 1072 (H.B. 3292), Acts of the
  85th Legislature, Regular Session, 2017, is repealed.
         SECTION 3.  Notwithstanding Section 32.0256(e), Human
  Resources Code, as added by this Act, the Health and Human Services
  Commission shall ensure that the initial report required under that
  subsection includes a description of the number of recipients
  described by Section 32.0256(a), Human Resources Code, as amended
  by this Act, who are living in a community-based, residential
  setting and whose eligibility for benefits was suspended or
  terminated during each month of the state fiscal years ending
  August 31, 2016, August 31, 2017, August 31, 2018, and August 31,
  2019.
         SECTION 4.  (a)  As soon as practicable after the effective
  date of this Act, the Health and Human Services Commission shall
  conduct a review of the commission's policies and processes
  relating to the renewal of Medicaid benefits for the following
  Medicaid recipients:
               (1)  persons receiving services through one of the
  following Medicaid programs authorized under Section 1915(c) of the
  federal Social Security Act (42 U.S.C. Section 1396n(c)) that
  provide services to persons with an intellectual or developmental
  disability:
                     (A)  the home and community-based services (HCS)
  waiver program; or
                     (B)  the Texas home living (TxHmL) waiver program;
  and
               (2)  persons residing in an ICF-IID facility.
         (b)  In conducting the review under this section, the Health
  and Human Services Commission shall:
               (1)  analyze existing data relating to:
                     (A)  the number of Medicaid recipients who lost
  eligibility for Medicaid benefits during each month of the state
  fiscal years ending August 31, 2016, August 31, 2017, August 31,
  2018, and August 31, 2019; and
                     (B)  the reasons for those recipients' loss of
  eligibility, including because of minor technical or clerical
  errors made on or with respect to a renewal application or other
  document required to renew eligibility for the benefits;
               (2)  evaluate the impact recipients' temporary loss of
  benefits has on the recipients and health care providers; and
               (3)  identify best practices for the commission,
  recipients and their legally authorized representatives, and
  health care providers to minimize recipients' loss of eligibility
  for the benefits because of:
                     (A)  minor technical or clerical errors made on or
  with respect to a renewal application or other document required to
  renew eligibility for the benefits; or
                     (B)  the recipient's failure to provide
  information necessary to renew eligibility for the benefits.
         (c)  Based on the findings of the review conducted under this
  section, the Health and Human Services Commission shall, in
  consultation with relevant stakeholders, develop a plan to
  implement best practices and address barriers to timely renewal of
  eligibility for Medicaid benefits and continuation of services for
  Medicaid recipients described by Subsection (a) of this section.  
  The plan must specifically identify best practices for avoiding
  loss of eligibility for Medicaid benefits by those recipients
  because of minor technical or clerical errors made on or with
  respect to a renewal application or other document required to
  renew eligibility for the benefits.
         (d)  Not later than November 1, 2022, the Health and Human
  Services Commission shall submit to the legislature the plan
  developed under Subsection (c) of this section. The plan must
  include:
               (1)  a summary of issues identified by the commission's
  review of policies and processes under this section;
               (2)  a timeline for the commission's implementation of
  the best practices identified for implementation in the review; and
               (3)  recommendations for potential legislation if the
  commission determines that changes in statute are required to
  address issues identified in the review.
         (e)  This section expires September 1, 2023.
         SECTION 5.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 6.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2021.