By: Rose H.B. No. 4194
A BILL TO BE ENTITLED
AN ACT
relating to the child health plan program and the medical
assistance program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Notwithstanding any other law, the executive
commissioner of the Health and Human Services Commission may adopt
rules to expand participation in and health benefits offered under
the child health plan program. Rules adopted under this Act may
include:
(1) new eligibility standards, including income
disregards and offsets;
(2) rules to expand the scope of services offered
under the program;
(3) rules to shorten or eliminate any waiting period;
and
(4) rules to expand marketing and outreach for the
program.
SECTION 2. Section 32.021(b), Human Resources Code, is
amended to read as follows:
(b) The department shall enter into agreements with any
federal agency designated by federal law to administer medical
assistance when the department determines the agreements to be
compatible with the state's participation in the medical assistance
program and within the limits of appropriated funds. The department
shall cooperate with federal agencies designated by federal law to
administer medical assistance in any reasonable manner necessary to
qualify for federal funds, including funds available under the
American Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5).
SECTION 3. Section 32.024, Human Resources Code, is amended
by amending Subsections (f), (l), (t), and (w) and adding
Subsections (z-2) and (ee) to read as follows:
(f) The department shall set the income eligibility cap for
persons qualifying for nursing home care at an amount that is not
less than $1,102 [$1,104] and that does not exceed the highest
income for which federal matching funds are payable. The department
shall set the cap at a higher amount than the minimum provided by
this subsection if appropriations made by the legislature for a
fiscal year will finance benefits at the higher cap for at least the
same number of recipients of the benefits during that year as were
served during the preceding fiscal year, as estimated by the
department. In setting an income eligibility cap under this
subsection, the department shall consider the cost of the
adjustment required by Subsection (g) of this section.
(l) The department shall set the income eligibility cap for
medical assistance for pregnant women and infants up to age one at
not less than 135 [130] percent of the federal poverty guidelines.
(t) The department by rule shall require a physician,
nursing facility, health care provider, or other responsible party
to obtain authorization from the department or a person authorized
to act on behalf of the department before an ambulance is used to
transport a recipient of medical assistance under this chapter in
circumstances not involving an emergency. The rules must provide
that:
(1) except as provided by Subdivision (3), a request
for authorization must be evaluated based on the recipient's
medical needs and may be granted for a length of time appropriate to
the recipient's medical condition;
(2) except as provided by Subdivision (3), a response
to a request for authorization must be made not later than 48 hours
after receipt of the request;
(3) a request for authorization must be immediately
granted and must be effective for a period of not more than 180 days
from the date of issuance if the request includes a written
statement from a physician that:
(A) states that alternative means of
transporting the recipient are contraindicated; and
(B) is dated not earlier than the 60th day before
the date on which the request for authorization is made;
(4) a person denied payment for ambulance services
rendered is entitled to payment from the nursing facility, health
care provider, or other responsible party that requested the
services if:
(A) payment under the medical assistance program
is denied because of lack of prior authorization; and
(B) the person provides the nursing facility,
health care provider, or other responsible party with a copy of the
bill for which payment was denied; and
(5) a person denied payment for services rendered
because of failure to obtain prior authorization or because a
request for prior authorization was denied is entitled to appeal
the denial of payment to the department.
(w) The department shall set a personal needs allowance of
not less than $70 [$60] a month for a resident of a convalescent or
nursing home or related institution licensed under Chapter 242,
Health and Safety Code, personal care facility, ICF-MR facility, or
other similar long-term care facility who receives medical
assistance. The department may send the personal needs allowance
directly to a resident who receives Supplemental Security Income
(SSI) (42 U.S.C. Section 1381 et seq.). This subsection does not
apply to a resident who is participating in a medical assistance
waiver program administered by the department.
(z-2) Notwithstanding any other law, the department, in its
rules and standards governing the vendor drug program, may not
limit to less than four the number of medications prescribed each
month to a recipient of prescription drug benefits under the
medical assistance program if one of those medications is
prescribed for 30 days or less and may not be refilled.
(ee) In its rules and standards governing the vendor drug
program, the department, to the maximum extent allowed by federal
law and subject to Subsection (z), shall provide medical assistance
to a recipient, including a recipient of medical assistance under
the Medicaid managed care program under Chapter 533, Government
Code, for the off-label use of a prescription medication if the
off-label use appears in one or more drug reference compendia and is
approved by the recipient's physician.
SECTION 4. Section 32.025, Human Resources Code, is amended
by adding Subsection (d-1) to read as follows:
(d-1) The procedures under Subsection (d) shall ensure that
children are screened simultaneously for eligibility under this
chapter and for eligibility under the child health plan program
under Chapter 62, Health and Safety Code, and the eligibility of a
child for the appropriate program is determined without further
eligibility application or qualification. This subsection applies
to an initial application and any subsequent recertification
review. The department shall ensure continuous coverage for an
eligible child who is transferred to a different program as a result
of the recertification review with no gap in coverage between the
two programs.
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 September 1, 2009.