| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to implementation of an express lane option for |
|
|
determining eligibility and enrolling certain individuals in |
|
|
Medicaid or the child health plan program. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 62.1011, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 62.1011. VERIFICATION OF INCOME. (a) Except as |
|
|
provided by Subsection (b) and subject to Subsection (c), the [The] |
|
|
commission shall continue employing methods of verifying the |
|
|
individual incomes of the individuals considered in the calculation |
|
|
of an applicant's household income. |
|
|
(b) The commission shall verify income under this section |
|
|
unless the applicant reports a household income that exceeds the |
|
|
income eligibility level established under Section 62.101(b). |
|
|
(c) The commission may verify income using the verification |
|
|
process described in Section 62.1012. |
|
|
SECTION 2. Subchapter C, Chapter 62, Health and Safety |
|
|
Code, is amended by adding Section 62.1012 to read as follows: |
|
|
Sec. 62.1012. EXPRESS LANE OPTION ELIGIBILITY; ENROLLMENT. |
|
|
(a) In this section: |
|
|
(1) "Express lane agency" means a governmental entity |
|
|
that: |
|
|
(A) determines eligibility for assistance under |
|
|
a public assistance program of this state; and |
|
|
(B) is designated by the executive commissioner |
|
|
as capable of making determinations of one or more eligibility |
|
|
requirements under the child health plan program. |
|
|
(2) "Public assistance program" includes: |
|
|
(A) the Medicaid program under Chapter 32, Human |
|
|
Resources Code; |
|
|
(B) the financial assistance program under |
|
|
Chapter 31, Human Resources Code; |
|
|
(C) the nutritional assistance programs under |
|
|
Chapter 33, Human Resources Code, including the supplemental |
|
|
nutrition assistance program under that chapter; and |
|
|
(D) other programs identified by the commission. |
|
|
(b) Notwithstanding any other law and in accordance with |
|
|
Sections 1902(e)(13) and 2107(e)(1)(H) of the Social Security Act |
|
|
(42 U.S.C. Sections 1396a(e)(13) and 1397gg(e)(1)(H)), the |
|
|
commission shall implement an express lane option under which the |
|
|
commission may rely on findings made by an express lane agency, |
|
|
including a division of an express lane agency, in determining a |
|
|
child's eligibility for coverage under the child health plan, |
|
|
including a child's eligibility for reenrollment in the plan. The |
|
|
commission shall use express lane eligibility by evaluating data |
|
|
received from an applicant under other public assistance programs |
|
|
to determine the applicant's eligibility for coverage under the |
|
|
child health plan. |
|
|
(c) In accordance with Section 1902(e)(13)(D) of the Social |
|
|
Security Act (42 U.S.C. Section 1396a(e)(13)(D)), the commission |
|
|
shall enroll in the child health plan program a child who is |
|
|
determined to be eligible for the program under this section, |
|
|
except that the child may only be enrolled in the program if the |
|
|
child's parent, legal guardian, or custodial relative |
|
|
affirmatively consents to the enrollment. The consent: |
|
|
(1) must be provided in accordance with identity |
|
|
verification standards the commission establishes; and |
|
|
(2) may be provided: |
|
|
(A) orally; |
|
|
(B) by telephone; |
|
|
(C) in writing, including: |
|
|
(i) by electronic signature; or |
|
|
(ii) in an application for coverage or |
|
|
benefits under a public assistance program; or |
|
|
(D) by any other manner the commission determines |
|
|
appropriate. |
|
|
(d) The commission and each express lane agency shall |
|
|
include in each application for coverage or benefits under a public |
|
|
assistance program, including any online application, and on the |
|
|
commission's or agency's Internet website a conspicuous notice |
|
|
clearly explaining that: |
|
|
(1) the information disclosed in the application may |
|
|
be used to determine a child's eligibility for coverage under the |
|
|
child health plan program using the express lane option implemented |
|
|
under this section; |
|
|
(2) the child's parent, legal guardian, or custodial |
|
|
relative may elect not to have the information disclosed for that |
|
|
purpose; and |
|
|
(3) the child's parent, legal guardian, or custodial |
|
|
relative must provide affirmative consent before the child may be |
|
|
enrolled in the child health plan program using the express lane |
|
|
option implemented under this section. |
|
|
(e) In accordance with 42 C.F.R. Section 457.340(e), the |
|
|
commission shall provide to the parent, legal guardian, or |
|
|
custodial relative of a child determined eligible for coverage |
|
|
under the child health plan program using the express lane option |
|
|
implemented under this section notice of that determination. The |
|
|
notice may be provided by mail, e-mail, or any other manner the |
|
|
commission determines appropriate. |
|
|
SECTION 3. Sections 32.026(e) and (g), Human Resources |
|
|
Code, are amended to read as follows: |
|
|
(e) The executive commissioner shall permit a |
|
|
recertification review of the eligibility and need for medical |
|
|
assistance of a child under 19 years of age to be conducted by |
|
|
telephone or mail instead of through a personal appearance at an |
|
|
office, unless the commission determines that the information |
|
|
needed to verify eligibility cannot be obtained in that manner or |
|
|
may be obtained in the manner specified by Section 32.026102. The |
|
|
executive commissioner by rule may develop procedures to determine |
|
|
whether there is a need for a recertification review of a child |
|
|
described by this subsection to be conducted through a personal |
|
|
interview with a commission representative. Procedures developed |
|
|
under this subsection shall be based on objective, risk-based |
|
|
factors and conditions and shall focus on a targeted group of |
|
|
recertification reviews for which there is a high probability that |
|
|
eligibility will not be recertified. |
|
|
(g) Notwithstanding any other provision of this code, the |
|
|
commission may use information obtained from a third party to |
|
|
verify the assets and resources of a person for purposes of |
|
|
determining the person's eligibility and need for medical |
|
|
assistance to the extent that verification is applicable under |
|
|
federal law. Third-party information includes information obtained |
|
|
from: |
|
|
(1) a consumer reporting agency, as defined by Section |
|
|
20.01, Business & Commerce Code; |
|
|
(2) an appraisal district; [or] |
|
|
(3) the Texas Department of Motor Vehicles vehicle |
|
|
registration record database; or |
|
|
(4) an express lane agency as defined by Section |
|
|
32.026102. |
|
|
SECTION 4. Subchapter B, Chapter 32, Human Resources Code, |
|
|
is amended by adding Section 32.026102 to read as follows: |
|
|
Sec. 32.026102. EXPRESS LANE OPTION ELIGIBILITY; |
|
|
ENROLLMENT. (a) In this section: |
|
|
(1) "Express lane agency" means a governmental entity |
|
|
that: |
|
|
(A) determines eligibility for assistance under |
|
|
a public assistance program of this state; and |
|
|
(B) is designated by the executive commissioner |
|
|
as capable of making determinations of one or more eligibility |
|
|
requirements under the medical assistance program. |
|
|
(2) "Public assistance program" includes: |
|
|
(A) the child health plan program under Chapters |
|
|
62 and 63, Health and Safety Code; |
|
|
(B) the financial assistance program under |
|
|
Chapter 31; |
|
|
(C) the nutritional assistance programs under |
|
|
Chapter 33, including the supplemental nutrition assistance |
|
|
program under that chapter; and |
|
|
(D) other programs identified by the commission. |
|
|
(b) Notwithstanding any other law and in accordance with |
|
|
Section 1902(e)(13) of the Social Security Act (42 U.S.C. Section |
|
|
1396a(e)(13)), the commission shall implement an express lane |
|
|
option under which the commission may rely on findings made by an |
|
|
express lane agency, including a division of an express lane |
|
|
agency, in determining a child's eligibility for medical |
|
|
assistance, including the recertification of a child's eligibility |
|
|
for medical assistance benefits. The commission shall use express |
|
|
lane eligibility by evaluating data received from an applicant |
|
|
under other public assistance programs to determine the applicant's |
|
|
eligibility for benefits under the medical assistance program. |
|
|
(c) In accordance with Section 1902(e)(13)(D) of the Social |
|
|
Security Act (42 U.S.C. Section 1396a(e)(13)(D)), the commission |
|
|
shall enroll in the medical assistance program a child who is |
|
|
determined to be eligible for the program under this section, |
|
|
except that the child may only be enrolled in the program if the |
|
|
child's parent, legal guardian, or custodial relative |
|
|
affirmatively consents to the enrollment. The consent: |
|
|
(1) must be provided in accordance with identity |
|
|
verification standards the commission establishes; and |
|
|
(2) may be provided: |
|
|
(A) orally; |
|
|
(B) by telephone; |
|
|
(C) in writing, including: |
|
|
(i) by electronic signature; or |
|
|
(ii) in an application for coverage or |
|
|
benefits under a public assistance program; or |
|
|
(D) by any other manner the commission determines |
|
|
appropriate. |
|
|
(d) The commission and each express lane agency shall |
|
|
include in each application for coverage or benefits under a public |
|
|
assistance program, including any online application, and on the |
|
|
commission's or agency's Internet website a conspicuous notice |
|
|
clearly explaining that: |
|
|
(1) the information disclosed in the application may |
|
|
be used to determine a child's eligibility for medical assistance |
|
|
benefits using the express lane option implemented under this |
|
|
section; |
|
|
(2) the child's parent, legal guardian, or custodial |
|
|
relative may elect not to have the information disclosed for that |
|
|
purpose; and |
|
|
(3) the child's parent, legal guardian, or custodial |
|
|
relative must provide affirmative consent before the child may be |
|
|
enrolled in the medical assistance program using the express lane |
|
|
option implemented under this section. |
|
|
(e) In accordance with 42 C.F.R. Section 435.917, the |
|
|
commission shall provide to the parent, legal guardian, or |
|
|
custodial relative of a child determined eligible for benefits |
|
|
under the medical assistance program using the express lane option |
|
|
implemented under this section notice of that determination. The |
|
|
notice may be provided by mail, e-mail, or any other manner the |
|
|
commission determines appropriate. |
|
|
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 on the 91st day after the last day of the |
|
|
legislative session. |