By: Rose H.B. No. 4951

A BILL TO BE ENTITLED

AN ACT

Relating to the Medicare Primacy Coordination Audit and Assistance Program to assist eligible individuals in obtaining certain Medicare benefits.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle I, Title 4, Government Code, is amended by adding Chapter 542 to read as follows:

CHAPTER 542. MEDICARE PRIMACY COORDINATION

AUDIT AND ASSISTANCE PROGRAM

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 542.0001. DEFINITIONS. In this chapter:

(1) "Eligible individual" means an individual who is eligible to participate in the program.

(2) "Program" means the Medicare Primacy Coordination Audit and Assistance Program established under this chapter.

SUBCHAPTER B. PROGRAM ADMINISTRATION

Sec. 542.0101. PROGRAM OBJECTIVE. The program's principal objective is to coordinate and integrate health plan benefits for individuals who are eligible for both Medicare and Medicaid.

Sec. 542.0102. PROGRAM PROMOTION. The commission shall promote and provide information about the program to individuals who:

(1) are potentially eligible to participate in the program; and

(2) live in medically underserved areas of this state.

Sec. 542.0103. COMMISSION'S DUTIES RELATED TO THE PROGRAM. The commission shall:

(1) conduct an ongoing claims analysis of adults receiving Medicaid for the purpose of identifying high-cost participants who may be eligible for Social Security Disability Insurance or Medicare benefits;

(2) monitor the program or program administrator through reporting requirements and other means to ensure contract performance and quality delivery of services;

(3) monitor the quality of services delivered to participants through outcome measurements; and

(4) assist any adult whose claims history and Social Security eligibility qualify to apply for and be awarded Social Security Disability and subsequently Medicare. The assistance shall include the following:

(A) developing communication materials to educate Medicaid recipients about Social Security Disability Insurance benefits;

(B) performing outreach to populations targeted by claims analysis;

(C) analyzing responses to determine Social Security Disability Insurance benefit or Medicare eligibility; and

(D) representing qualified individuals with their claim or claims to qualify for Social Security Disability Insurance benefits and Medicare enrollment.

Sec. 542.0105. THIRD-PARTY ADMINISTRATOR CONTRACT FOR PROGRAM IMPLEMENTATION. (a) In administering the program, the commission may contract with a qualified and experienced third-party administrator to provide enrollment and related services.

(b) If the commission contracts with a third-party administrator under this section, the commission shall:

(1) monitor the third-party administrator through reporting requirements and other means to ensure contract performance and quality delivery of services; and

(2) provide payment under the contract to the third-party administrator.

(c) The executive commissioner shall retain all policymaking authority over the program.

(d) The commission shall procure each contract with a third-party administrator, as applicable, through a competitive procurement process that complies with all federal and state laws.

(e) The administrator shall provide the commission and the legislature with an annual report showing the number of Medicaid recipients who have transitioned to Social Security Disability Insurance and Medicare and the amount of savings realized by the State of Texas.

SUBCHAPTER C. ELIGIBILITY FOR PROGRAM

Sec. 542.0151. ELIGIBILITY REQUIREMENTS. (a) An individual is eligible to enroll in the program if the individual is:

(1) enrolled or currently receiving Medicaid benefits; and

(2) meets the eligibility criteria for Social Security Disability Insurance or Medicare benefits.

Sec. 542.0153. APPLICATION FORM AND PROCEDURES. (a) The executive commissioner shall adopt an application form and application procedures for the program. The form and procedures must be coordinated with forms and procedures under Medicare or Social Security Disability Insurance to ensure that there is a single consolidated application process to seek health benefit coverage under the program.

(b) To the extent possible, the commission shall make the application form available in languages other than English.

(c) The executive commissioner may permit an individual to apply by mail, over the telephone, or through the Internet.

Sec. 537A.0154. ELIGIBILITY SCREENING AND ENROLLMENT. (a) The executive commissioner shall adopt eligibility screening and enrollment procedures or use the Texas Integrated Enrollment Services eligibility determination system or a compatible system to screen individuals and enroll eligible individuals in the program.

(b) The executive commissioner may establish enrollment periods for the program.

SECTION 2. 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, 2023.