82R22116 KFF-F
By: Parker H.B. No. 2368
Substitute the following for H.B. No. 2368:
By: Truitt C.S.H.B. No. 2368
A BILL TO BE ENTITLED
AN ACT
relating to copayments and other cost-sharing payments under the
medical assistance program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 32.064(a) and (b), Human Resources
Code, are amended to read as follows:
(a) To the extent permitted under Title XIX, Social Security
Act (42 U.S.C. Section 1396 et seq.), as amended, and any other
applicable law or regulations, the executive commissioner of the
Health and Human Services Commission shall adopt provisions
requiring recipients of medical assistance to share the cost of
medical assistance, including provisions requiring recipients to
pay:
(1) an enrollment fee;
(2) a deductible; [or]
(3) coinsurance or a portion of the plan premium, if
the recipients receive medical assistance under the Medicaid
managed care program under Chapter 533, Government Code, or a
Medicaid managed care demonstration project under Section 32.041;
or
(4) a copayment in accordance with Section 32.0641(c).
(b) Subject to Subsection (d) and except as provided by
Section 32.0641(c), cost-sharing provisions adopted under this
section shall ensure that families with higher levels of income are
required to pay progressively higher percentages of the cost of the
medical assistance.
SECTION 2. The heading to Section 32.0641, Human Resources
Code, is amended to read as follows:
Sec. 32.0641. COST SHARING FOR CERTAIN HEALTH CARE
[HIGH-COST MEDICAL] SERVICES.
SECTION 3. Section 32.0641, Human Resources Code, is
amended by amending Subsections (a) and (c) and adding Subsections
(a-1) and (d) to read as follows:
(a) To [If the department determines that it is feasible and
cost-effective, and to] the extent permitted under Title XIX,
Social Security Act (42 U.S.C. Section 1396 et seq.) and any other
applicable law or regulation or under a federal waiver or other
authorization, and subject to Subsection (c), the executive
commissioner of the Health and Human Services Commission shall
adopt cost-sharing provisions that encourage personal
accountability and appropriate utilization of health care
services.
(a-1) The executive commissioner of the Health and Human
Services Commission shall adopt a cost-sharing provision under
Subsection (a) that requires [require] a recipient who chooses to
receive a nonemergency [a high-cost] medical service [provided]
through a hospital emergency room to pay a copayment[, premium
payment,] or other cost-sharing payment for the nonemergency
[high-cost] medical service if:
(1) the hospital from which the recipient seeks
service:
(A) performs an appropriate medical screening
and determines that the recipient does not have a condition
requiring emergency medical services;
(B) informs the recipient:
(i) that the recipient does not have a
condition requiring emergency medical services;
(ii) that, if the hospital provides the
nonemergency medical service, the hospital may require payment of a
copayment[, premium payment,] or other cost-sharing payment by the
recipient in advance; and
(iii) of the name and address of a
nonemergency Medicaid provider who can provide the appropriate
medical service without imposing a cost-sharing payment; and
(C) offers to provide the recipient with a
referral to the nonemergency provider to facilitate scheduling of
the service; and
(2) after receiving the information and assistance
described by Subdivision (1) from the hospital, the recipient
chooses to obtain [emergency] medical services through the hospital
emergency room despite having access to appropriate and medically
acceptable[, lower-cost] medical services.
(c) If the executive commissioner of the Health and Human
Services Commission adopts copayments [a copayment or other
cost-sharing payment] under Subsection (a) for the following health
care services, the executive commissioner shall require that a
recipient pay copayments in the following amounts:
(1) not more than $5 for each hospital outpatient
visit at the time of the visit, other than a visit for a
nonemergency medical service provided through a hospital emergency
room;
(2) not more than $5 for each medical visit with a
physician at the time of the visit; and
(3) not more than $7.50 per prescription drug
[commission may not reduce hospital payments to reflect the
potential receipt of a copayment or other payment from a recipient
receiving medical services provided through a hospital emergency
room].
(d) Subsection (c) does not require a medical assistance
provider to bill or collect from a recipient a copayment required or
authorized under this section.
SECTION 4. 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 5. This Act takes effect September 1, 2011.