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A BILL TO BE ENTITLED
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AN ACT
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relating to presumptive eligibility of certain individuals for |
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nursing facility care under Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.02605 to read as follows: |
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Sec. 32.02605. PRESUMPTIVE ELIGIBILITY OF CERTAIN |
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APPLICANTS NEEDING NURSING FACILITY CARE. (a) In this section: |
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(1) "Applicant" means an applicant for medical |
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assistance. |
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(2) "Nursing facility" means a convalescent or nursing |
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home or related institution licensed under Chapter 242, Health and |
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Safety Code, that provides long-term services and supports to |
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residents of the facility. |
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(b) The executive commissioner shall by rule develop and |
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implement a process providing for the determination and |
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certification of presumptive eligibility for medical assistance of |
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an applicant who needs nursing facility care. |
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(c) The process established under this section must: |
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(1) provide medical assistance benefits under a |
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presumptive eligibility determination for a period of not more than |
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90 days; |
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(2) provide a preliminary screening tool to nursing |
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facilities that will allow the facilities to make a reasonable |
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determination as to whether an applicant: |
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(A) meets the level of care criteria for medical |
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necessity for nursing facility care; and |
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(B) is likely to be eligible for medical |
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assistance; and |
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(3) require an applicant to sign a written agreement: |
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(A) attesting to the accuracy of financial and |
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other information the applicant provides and on which presumptive |
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eligibility is based; and |
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(B) acknowledging that: |
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(i) state-funded services are subject to |
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the period prescribed by Subdivision (1); and |
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(ii) the applicant is required to comply |
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with Subsection (d). |
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(d) An individual must complete and submit an application |
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for medical assistance before the individual may be determined |
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presumptively eligible for medical assistance under the process |
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established by the commission under this section. |
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(e) Not later than the 45th day after the date the |
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commission receives an application under Subsection (d), the |
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commission shall make a final determination of eligibility for |
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medical assistance. |
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(f) To the extent permitted by federal law, the commission |
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shall retroactively apply a final determination of eligibility for |
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medical assistance under Subsection (e) for a period that does not |
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exceed the 90-day period prescribed by Subsection (c)(1). |
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(g) To the extent permitted by federal law and subject to |
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Subsection (h), if the commission fails to make a final |
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determination of eligibility within the 45-day period required by |
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Subsection (e), the commission, at the request of a nursing |
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facility, shall provide medical assistance reimbursement to the |
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facility for health care services the facility provides to an |
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applicant during the period the applicant is determined |
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presumptively eligible for medical assistance under this section. |
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(h) If the commission makes a final determination that an |
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applicant for whom reimbursement is provided under Subsection (g) |
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is not eligible for medical assistance, the nursing facility must |
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pay back all money received by the facility as reimbursement under |
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that subsection. The commission may provide medical assistance |
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reimbursement to a nursing facility under Subsection (g) only if |
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the facility agrees in writing to comply with this subsection. |
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(i) The executive commissioner shall adopt rules necessary |
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to implement this section, including rules prescribing the form and |
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manner a nursing facility: |
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(1) may request medical assistance reimbursement |
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under Subsection (g); and |
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(2) if an applicant is determined ineligible for |
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medical assistance, pays back the money received by the facility |
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under Subsection (h). |
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SECTION 2. 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 3. This Act takes effect September 1, 2025. |