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A BILL TO BE ENTITLED
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AN ACT
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relating to establishing an assistance program to provide certain |
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health care services to certain medically fragile children. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle C, Title 2, Human Resources Code, is |
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amended by adding Chapter 37 to read as follows: |
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CHAPTER 37. MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM |
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Sec. 37.001. DEFINITIONS. In this chapter: |
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(1) "Child health plan program" means the child health |
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plan program established under Chapters 62 and 63, Health and |
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Safety Code. |
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(2) "Medicaid" means the medical assistance program |
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established under Chapter 32. |
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(3) "Medically fragile child" means a person younger |
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than 21 years of age who is: |
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(A) chronically ill or disabled and requires |
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indefinite skilled nursing care to maintain the person's existence |
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in the person's home; |
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(B) temporarily ill or disabled because of |
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premature birth, accident, or trauma and has experienced a |
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temporary lifestyle change requiring skilled nursing care; |
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(C) suffering from uncontrollable seizures or |
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other chronic illness; or |
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(D) chronically dependent on medical devices to |
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perform vital bodily functions. |
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(4) "Program" means the program to provide health care |
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services to medically fragile children established under Section |
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37.002. |
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(5) "Wrap-around benefits" means a service, including |
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a pharmacy or medical benefit: |
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(A) not covered under a private health benefit |
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plan or a public benefit program, including Medicaid and the child |
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health plan program, in which the child is enrolled; or |
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(B) covered under a private health benefit plan |
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in which the child is enrolled but the child has exceeded the |
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private health benefit plan coverage limit. |
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Sec. 37.002. ESTABLISHMENT OF PROGRAM. The commission, |
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exclusive of Medicaid, by rule shall develop and implement a |
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program under which health care services are provided to medically |
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fragile children with a rare and unique disease or medical |
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condition. The program must: |
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(1) provide benefits based on a child's diagnosis; and |
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(2) be designed to provide wrap-around benefits to |
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children participating in the program. |
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Sec. 37.003. ELIGIBLE CHILDREN. (a) The executive |
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commissioner by rule shall identify the diagnoses considered rare |
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and unique for purposes of determining eligibility under the |
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program. |
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(b) The executive commissioner may not impose income |
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eligibility requirements under the program. |
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Sec. 37.004. COVERED HEALTH CARE SERVICES. (a) Eligible |
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health care services under the program must include: |
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(1) specialized nutritional support, including |
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enteral nutrition; |
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(2) physical or occupational therapy; |
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(3) speech therapy; |
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(4) music therapy; |
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(5) aqua-therapy; |
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(6) hippotherapy; |
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(7) private duty nursing services in home or |
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educational environments; |
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(8) chiropractic services; and |
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(9) any other health care service or therapy the |
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commission determines necessary. |
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(b) To receive services under the program, the executive |
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commissioner may require that a participant provide evidence: |
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(1) from a health care provider that the proposed |
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services are medically necessary; and |
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(2) if the participant has private health benefit plan |
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coverage, that: |
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(A) the service is not covered under the plan; |
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(B) the issuer has denied coverage under the |
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plan; or |
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(C) the participant has met the applicable |
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coverage limit under the plan. |
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Sec. 37.005. MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM |
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ACCOUNT. (a) The medically fragile children assistance program |
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account is an account in the general revenue fund. |
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(b) The account consists of: |
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(1) appropriations of money to the account by the |
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legislature; |
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(2) gifts, grants, including federal grants, and other |
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donations received under Section 37.006; and |
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(3) interest earned on the investment of money in the |
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account. |
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(c) Money in the account may be appropriated only to the |
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commission for purposes of the program. |
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Sec. 37.006. GIFTS, GRANTS, AND DONATIONS. The commission |
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may accept gifts, grants, and donations from any source that are |
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made for the purposes of the program. The commission shall deposit |
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money received under this section to the credit of the medically |
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fragile children assistance program account. |
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SECTION 2. Not later than January 1, 2022, the Health and |
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Human Services Commission shall establish the program to provide |
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health care services to medically fragile children established |
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under Section 37.002, Human Resources Code, as added by this Act. |
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SECTION 3. This Act takes effect September 1, 2021. |