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A BILL TO BE ENTITLED
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AN ACT
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relating to the establishment of the case assistance affiliate |
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program to provide certain assistance to Medicaid recipients and |
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child health plan program enrollees. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 545, Government Code, as effective April |
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1, 2025, is amended by adding Subchapter F to read as follows: |
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SUBCHAPTER F. CASE ASSISTANCE AFFILIATE PROGRAM |
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Sec. 545.0251. DEFINITIONS. In this subchapter: |
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(1) "Benefit case management services" means |
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assisting a client or member of the client's household to apply for |
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and manage other benefits for which the client may be eligible. |
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(2) "Case assistance" means providing a client: |
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(A) application and renewal assistance under |
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Medicaid or the child health plan program, as appropriate; and |
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(B) benefit case management services under |
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public benefits programs, including the financial and nutritional |
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assistance programs. |
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(3) "Case assistance affiliate" means a managed care |
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organization or dental maintenance organization that provides case |
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assistance to clients and members of the clients' households. |
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(4) "Case assistant" means an employee of a case |
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assistance affiliate who directly provides case assistance to a |
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client or a member of the client's household. |
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(5) "Client" means, with respect to a managed care |
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organization or dental maintenance organization, a recipient or |
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enrollee who is enrolled in the organization's managed care plan. |
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(6) "Enrollee" means an individual enrolled in the |
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child health plan program. |
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(7) "Program" means the case assistance affiliate |
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program established under this subchapter. |
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(8) "Program manager" means the employee of a case |
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assistance affiliate who is designated by the affiliate to oversee: |
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(A) case assistants; and |
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(B) the provision of case assistance services |
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under the program. |
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(9) "Recipient" means a Medicaid recipient. |
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Sec. 545.0252. ESTABLISHMENT OF CASE ASSISTANCE AFFILIATE |
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PROGRAM. (a) The commission shall: |
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(1) establish a statewide case assistance affiliate |
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program under which managed care organizations and dental |
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maintenance organizations that participate in Medicaid or the child |
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health plan program are authorized to operate as case assistance |
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affiliates by providing, to the extent permitted by federal law, |
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case assistance to their clients and members of their clients' |
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households; and |
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(2) provide a training and certification process for |
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program managers and case assistants providing services under the |
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program. |
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(b) In establishing the program, the commission: |
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(1) shall consult with: |
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(A) experts, as determined by the commission; and |
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(B) other interested persons, including managed |
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care organizations and dental maintenance organizations |
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participating in Medicaid or the child health plan program; and |
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(2) may establish a work group or advisory committee |
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that includes interested persons to advise the commission on the |
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establishment of the program. |
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Sec. 545.0253. AUTHORIZED SERVICES. Under the program, a |
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case assistance affiliate may: |
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(1) provide case assistance by any appropriate means, |
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including in person or virtually using a computer, tablet, or other |
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electronic device; and |
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(2) with the consent of the client, submit to the |
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commission an application for benefits on behalf of the client |
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using the client's captured electronic signature. |
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Sec. 545.0254. PROHIBITED SERVICES. Under the program, a |
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case assistance affiliate may not: |
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(1) provide counseling to a client on choosing a |
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managed care plan in which to enroll; or |
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(2) assist a client in completing fields on benefit |
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forms associated with managed care plan selection. |
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Sec. 545.0255. RULES: PROGRAM REQUIREMENTS AND STANDARDS. |
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The executive commissioner shall adopt rules necessary to implement |
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the program, including rules: |
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(1) establishing requirements for a managed care |
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organization or dental maintenance organization to participate in |
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the program; |
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(2) establishing the training and certification |
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process required by Section 545.0252(a)(2); |
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(3) providing for the suspension, revocation, and, as |
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appropriate, periodic renewal of a case assistant's or program |
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manager's certification; |
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(4) protecting the confidentiality of clients' |
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information; and |
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(5) establishing any other standards or requirements |
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the executive commissioner determines necessary. |
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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 immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2025. |