81R8199 KLA-D
By: Zaffirini S.B. No. 1252
A BILL TO BE ENTITLED
AN ACT
relating to improving application and eligibility determination
processes and efficiencies for certain benefits programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0992 to read as follows:
Sec. 531.0992. COMMUNITY OUTREACH FOR BENEFITS PROGRAMS.
(a) In this section, "benefits program" includes:
(1) the child health plan program;
(2) the financial assistance program under Chapter 31,
Human Resources Code;
(3) the medical assistance program under Chapter 32,
Human Resources Code, including long-term care services provided
under the program; and
(4) the food stamp program under Chapter 33, Human
Resources Code.
(b) The commission shall improve the effectiveness of
community outreach efforts with respect to benefits programs. To
improve that effectiveness, the commission shall:
(1) increase the capacity of existing outreach efforts
implemented through community-based organizations by providing
those organizations with adequate resources to:
(A) educate the public about benefits programs;
(B) provide assistance to the public in
completing applications for eligibility or recertification of
eligibility and obtaining required documentation for applications;
and
(C) assist applicants in resolving problems
encountered during the eligibility determination process; and
(2) establish a partnership with stakeholders who will
provide outreach and application assistance by:
(A) fostering the exchange of information
regarding, and promoting, best practices for obtaining health
benefits coverage for children;
(B) assisting the commission in designing and
implementing processes to reduce procedural denials under Section
531.474; and
(C) disseminating successful outreach models
across this state under which entities such as hospitals, school
districts, and local businesses partner to identify children
without health benefits coverage.
(c) The partnership established under Subsection (b)(2)
must include entities that contract with the commission to perform
child health plan and medical assistance program eligibility
determination and enrollment functions, community-based
organizations that contract with the commission, health benefit
plan providers, Texas Health Steps program contractors, health care
providers, consumer advocates, and other interested stakeholders.
(d) The commission may also improve the effectiveness of
community outreach efforts with respect to benefits programs by
contracting with one or more persons to provide outreach and
application assistance for the programs. The commission shall
require each potential contractor under this subsection to indicate
the person's interest in writing before submitting a proposal for a
contract. If more than one person from a geographic area determined
by the commission submits a letter of interest, the commission
shall encourage the persons from that area to collaborate on a
proposal for a contract.
(e) To the extent practicable, the commission shall give
preference in awarding contracts under Subsection (d) to proposals
submitted by collaborations that include multiple entities with
experience in serving a variety of populations, including
populations that more commonly enroll in or receive benefits under
benefits programs.
SECTION 2. Chapter 531, Government Code, is amended by
adding Subchapter M-1 to read as follows:
SUBCHAPTER M-1. ELIGIBILITY DETERMINATION STREAMLINING
AND IMPROVEMENT
Sec. 531.471. DEFINITIONS. In this subchapter:
(1) "Benefits program" includes:
(A) the child health plan program;
(B) the financial assistance program under
Chapter 31, Human Resources Code;
(C) the medical assistance program under Chapter
32, Human Resources Code, including long-term care services
provided under the program; and
(D) the food stamp program under Chapter 33,
Human Resources Code.
(2) "SAVERR" means the System of Application,
Verification, Eligibility, Referral, and Reporting.
(3) "TIERS" means the Texas Integrated Eligibility
Redesign System.
Sec. 531.472. APPLICATION PROCESSING STANDARDS AND
PROCEDURES. (a) The executive commissioner by rule shall adopt for
benefits programs:
(1) a methodology for establishing minimum levels of
eligibility determination staff, qualifications for that staff,
and the maximum caseload per staff person, that will ensure that:
(A) benefits program eligibility determinations
are made within applicable processing time requirements
established by state and federal law and are accurately made; and
(B) case appeals and enrollee recipient
information changes are timely processed; and
(2) in addition to streamlined administrative
processes implemented under Section 531.02411, eligibility
determination procedures that enhance efficiencies and eliminate
unnecessary administrative requirements in making those
determinations.
(b) In adopting the methodology and procedures required by
Subsection (a), the executive commissioner must ensure that it is
feasible, under both SAVERR and TIERS, evaluated separately, to
achieve a goal of processing at least 95 percent of the applications
and eligibility recertifications for benefits programs within the
applicable processing time requirements established by state and
federal law.
(c) The methodology for establishing staffing levels and
staff qualifications and maximum caseloads adopted under
Subsection (a) must apply with respect to all eligibility
determination staff persons, regardless of whether those persons
are state employees, contractors, or contractors' employees.
Sec. 531.473. CORRECTIVE ACTION PLAN. (a) The executive
commissioner shall develop and implement a corrective action plan
for application and eligibility recertification determination
processes for benefits programs if, for three consecutive months:
(1) less than 90 percent of the applications or
eligibility recertifications for benefits programs are accurately
processed through SAVERR within the applicable processing time
requirements established by state and federal law; or
(2) less than 90 percent of the applications or
eligibility recertifications for benefits programs are accurately
processed through TIERS within the applicable processing time
requirements established by state and federal law.
(b) A corrective action plan:
(1) must require the implementation of changes
specifically designed to target the processing time or accuracy
factors that required the implementation of the plan, which may
include implementing changes with respect to contractors or changes
to address TIERS defects or staff training; and
(2) may authorize the commission to take necessary
actions to hire additional eligibility determination staff,
including requesting that the Legislative Budget Board take action
as provided by Chapter 317 to make money available for that purpose.
Sec. 531.474. REDUCTION OF PROCEDURAL DENIALS. (a) In this
section, "procedural denial" includes:
(1) a denial of eligibility solely because information
is missing from an application; and
(2) an automatic denial of eligibility because an
enrollee or recipient, the parent or legal guardian of an enrollee
or recipient, or an eligibility determination staff person or
contractor fails to take necessary actions for recertification of
eligibility.
(b) In consultation with the partnership with stakeholders
established under Section 531.0992, the executive commissioner
shall adopt, and the commission shall implement, processes designed
to reduce to the lowest practicable level the incidence of
procedural denials of eligibility for benefits programs.
(c) Processes adopted under Subsection (b) may include:
(1) providing specific instructions to applicants,
enrollees, and recipients, or their parents or legal guardians,
regarding acceptable documentation of income for purposes of an
eligibility determination, including instructions for documenting
income from part-time employment, contract employment, and income
paid in cash or by personal check;
(2) contacting by telephone enrollees and recipients,
or the parents and legal guardians of enrollees and recipients, who
do not complete required forms for recertification of eligibility;
and
(3) allowing an applicant, enrollee, or recipient, or
the parent or legal guardian of an applicant, enrollee, or
recipient, a period to provide information that is missing from an
application for an initial determination or recertification of
eligibility and the lack of which would otherwise cause a
procedural denial, instead of requiring the person to submit a new
application.
(d) If the commission implements a telephone contact
process as described by Subsection (c)(2), the contacts may be made
by commission employees or by entities that contract with the
commission.
(e) The commission shall specify the period during which
missing information described by Subsection (c)(3) may be provided
to avoid a procedural denial. The period may not be less than 10
business days after the date an applicant, enrollee, or recipient,
or the parent or legal guardian of the applicant, enrollee, or
recipient, is notified that the information is missing.
Sec. 531.475. CALL RESOLUTION STANDARDS. (a) The
executive commissioner by rule shall adopt:
(1) telephone call resolution standards and processes
for each call center established under Section 531.063, including a
call center operated by a contractor, to increase the percentage of
telephone calls regarding questions, issues, or complaints
received at call centers that are successfully resolved; and
(2) a process for receiving and resolving issues and
complaints from a person who applies for an initial determination
or recertification of eligibility for a benefits program,
regardless of whether the person applied through a call center, a
local eligibility determination office, or mail correspondence.
(b) Standards adopted under Subsection (a)(1) must specify
the criteria by which the resolution of a telephone call received at
a call center will be evaluated. The criteria may include hold
times and call abandonment rates, but must include additional
measures the executive commissioner determines appropriate.
(c) To be considered for a contract to operate a call center
under Section 531.063, a person must include in the proposal for the
contract a specific description of the means by which the person
will ensure compliance with the standards adopted under Subsection
(a)(1) if awarded the contract. Each contract entered into by the
commission and a person to operate a call center must include terms
regarding the means by which the contractor will ensure that
compliance.
SECTION 3. Effective September 1, 2009, Section 32.0261,
Human Resources Code, is amended to read as follows:
Sec. 32.0261. CONTINUOUS ELIGIBILITY. The department
shall adopt rules in accordance with 42 U.S.C. Section
1396a(e)(12), as amended, to provide for a period of continuous
eligibility for a child under 19 years of age who is determined to
be eligible for medical assistance under this chapter. The rules
shall provide that the child remains eligible for medical
assistance, without additional review by the department and
regardless of changes in the child's resources or income, until the
earlier of:
(1) the first anniversary of [end of the six-month
period following] the date on which the child's eligibility was
determined; or
(2) the child's 19th birthday.
SECTION 4. Section 531.475(c), Government Code, as added by
this Act, applies to a proposal for a contract for the operation of
a call center submitted, and a contract for the operation of a call
center entered into or renewed, on or after September 1, 2009. A
proposal for a contract submitted, or a contract entered into or
renewed, before that date is governed by the law in effect on the
date the proposal was submitted or the contract was entered into or
renewed, and the former law is continued in effect for that purpose.
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 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, 2009.