Texas 2009 - 81st Regular

Texas House Bill HB4194 Compare Versions

Only one version of the bill is available at this time.

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1	1	By: Rose H.B. No. 4194
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the child health plan program and the medical
7	7	assistance program.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Notwithstanding any other law, the executive
10	10	commissioner of the Health and Human Services Commission may adopt
11	11	rules to expand participation in and health benefits offered under
12	12	the child health plan program. Rules adopted under this Act may
13	13	include:
14	14	(1) new eligibility standards, including income
15	15	disregards and offsets;
16	16	(2) rules to expand the scope of services offered
17	17	under the program;
18	18	(3) rules to shorten or eliminate any waiting period;
19	19	and
20	20	(4) rules to expand marketing and outreach for the
21	21	program.
22	22	SECTION 2. Section 32.021(b), Human Resources Code, is
23	23	amended to read as follows:
24	24	(b) The department shall enter into agreements with any
25	25	federal agency designated by federal law to administer medical
26	26	assistance when the department determines the agreements to be
27	27	compatible with the state's participation in the medical assistance
28	28	program and within the limits of appropriated funds. The department
29	29	shall cooperate with federal agencies designated by federal law to
30	30	administer medical assistance in any reasonable manner necessary to
31	31	qualify for federal funds, including funds available under the
32	32	American Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5).
33	33	SECTION 3. Section 32.024, Human Resources Code, is amended
34	34	by amending Subsections (f), (l), (t), and (w) and adding
35	35	Subsections (z-2) and (ee) to read as follows:
36	36	(f) The department shall set the income eligibility cap for
37	37	persons qualifying for nursing home care at an amount that is not
38	38	less than $1,102 [$1,104] and that does not exceed the highest
39	39	income for which federal matching funds are payable. The department
40	40	shall set the cap at a higher amount than the minimum provided by
41	41	this subsection if appropriations made by the legislature for a
42	42	fiscal year will finance benefits at the higher cap for at least the
43	43	same number of recipients of the benefits during that year as were
44	44	served during the preceding fiscal year, as estimated by the
45	45	department. In setting an income eligibility cap under this
46	46	subsection, the department shall consider the cost of the
47	47	adjustment required by Subsection (g) of this section.
48	48	(l) The department shall set the income eligibility cap for
49	49	medical assistance for pregnant women and infants up to age one at
50	50	not less than 135 [130] percent of the federal poverty guidelines.
51	51	(t) The department by rule shall require a physician,
52	52	nursing facility, health care provider, or other responsible party
53	53	to obtain authorization from the department or a person authorized
54	54	to act on behalf of the department before an ambulance is used to
55	55	transport a recipient of medical assistance under this chapter in
56	56	circumstances not involving an emergency. The rules must provide
57	57	that:
58	58	(1) except as provided by Subdivision (3), a request
59	59	for authorization must be evaluated based on the recipient's
60	60	medical needs and may be granted for a length of time appropriate to
61	61	the recipient's medical condition;
62	62	(2) except as provided by Subdivision (3), a response
63	63	to a request for authorization must be made not later than 48 hours
64	64	after receipt of the request;
65	65	(3) a request for authorization must be immediately
66	66	granted and must be effective for a period of not more than 180 days
67	67	from the date of issuance if the request includes a written
68	68	statement from a physician that:
69	69	(A) states that alternative means of
70	70	transporting the recipient are contraindicated; and
71	71	(B) is dated not earlier than the 60th day before
72	72	the date on which the request for authorization is made;
73	73	(4) a person denied payment for ambulance services
74	74	rendered is entitled to payment from the nursing facility, health
75	75	care provider, or other responsible party that requested the
76	76	services if:
77	77	(A) payment under the medical assistance program
78	78	is denied because of lack of prior authorization; and
79	79	(B) the person provides the nursing facility,
80	80	health care provider, or other responsible party with a copy of the
81	81	bill for which payment was denied; and
82	82	(5) a person denied payment for services rendered
83	83	because of failure to obtain prior authorization or because a
84	84	request for prior authorization was denied is entitled to appeal
85	85	the denial of payment to the department.
86	86	(w) The department shall set a personal needs allowance of
87	87	not less than $70 [$60] a month for a resident of a convalescent or
88	88	nursing home or related institution licensed under Chapter 242,
89	89	Health and Safety Code, personal care facility, ICF-MR facility, or
90	90	other similar long-term care facility who receives medical
91	91	assistance. The department may send the personal needs allowance
92	92	directly to a resident who receives Supplemental Security Income
93	93	(SSI) (42 U.S.C. Section 1381 et seq.). This subsection does not
94	94	apply to a resident who is participating in a medical assistance
95	95	waiver program administered by the department.
96	96	(z-2) Notwithstanding any other law, the department, in its
97	97	rules and standards governing the vendor drug program, may not
98	98	limit to less than four the number of medications prescribed each
99	99	month to a recipient of prescription drug benefits under the
100	100	medical assistance program if one of those medications is
101	101	prescribed for 30 days or less and may not be refilled.
102	102	(ee) In its rules and standards governing the vendor drug
103	103	program, the department, to the maximum extent allowed by federal
104	104	law and subject to Subsection (z), shall provide medical assistance
105	105	to a recipient, including a recipient of medical assistance under
106	106	the Medicaid managed care program under Chapter 533, Government
107	107	Code, for the off-label use of a prescription medication if the
108	108	off-label use appears in one or more drug reference compendia and is
109	109	approved by the recipient's physician.
110	110	SECTION 4. Section 32.025, Human Resources Code, is amended
111	111	by adding Subsection (d-1) to read as follows:
112	112	(d-1) The procedures under Subsection (d) shall ensure that
113	113	children are screened simultaneously for eligibility under this
114	114	chapter and for eligibility under the child health plan program
115	115	under Chapter 62, Health and Safety Code, and the eligibility of a
116	116	child for the appropriate program is determined without further
117	117	eligibility application or qualification. This subsection applies
118	118	to an initial application and any subsequent recertification
119	119	review. The department shall ensure continuous coverage for an
120	120	eligible child who is transferred to a different program as a result
121	121	of the recertification review with no gap in coverage between the
122	122	two programs.
123	123	SECTION 5. If before implementing any provision of this Act
124	124	a state agency determines that a waiver or authorization from a
125	125	federal agency is necessary for implementation of that provision,
126	126	the agency affected by the provision shall request the waiver or
127	127	authorization and may delay implementing that provision until the
128	128	waiver or authorization is granted.
129	129	SECTION 6. This Act takes effect September 1, 2009.