Texas 2011 - 82nd Regular

Texas House Bill HB2368 Compare Versions

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Old	New	Differences
1	1	82R22116 KFF-F
2	2	By: Parker H.B. No. 2368
3	3	Substitute the following for H.B. No. 2368:
4	4	By: Truitt C.S.H.B. No. 2368
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to copayments and other cost-sharing payments under the
10	10	medical assistance program.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Sections 32.064(a) and (b), Human Resources
13	13	Code, are amended to read as follows:
14	14	(a) To the extent permitted under Title XIX, Social Security
15	15	Act (42 U.S.C. Section 1396 et seq.), as amended, and any other
16	16	applicable law or regulations, the executive commissioner of the
17	17	Health and Human Services Commission shall adopt provisions
18	18	requiring recipients of medical assistance to share the cost of
19	19	medical assistance, including provisions requiring recipients to
20	20	pay:
21	21	(1) an enrollment fee;
22	22	(2) a deductible; [or]
23	23	(3) coinsurance or a portion of the plan premium, if
24	24	the recipients receive medical assistance under the Medicaid
25	25	managed care program under Chapter 533, Government Code, or a
26	26	Medicaid managed care demonstration project under Section 32.041;
27	27	or
28	28	(4) a copayment in accordance with Section 32.0641(c).
29	29	(b) Subject to Subsection (d) and except as provided by
30	30	Section 32.0641(c), cost-sharing provisions adopted under this
31	31	section shall ensure that families with higher levels of income are
32	32	required to pay progressively higher percentages of the cost of the
33	33	medical assistance.
34	34	SECTION 2. The heading to Section 32.0641, Human Resources
35	35	Code, is amended to read as follows:
36	36	Sec. 32.0641. COST SHARING FOR CERTAIN HEALTH CARE
37	37	[HIGH-COST MEDICAL] SERVICES.
38	38	SECTION 3. Section 32.0641, Human Resources Code, is
39	39	amended by amending Subsections (a) and (c) and adding Subsections
40	40	(a-1) and (d) to read as follows:
41	41	(a) To [If the department determines that it is feasible and
42	42	cost-effective, and to] the extent permitted under Title XIX,
43	43	Social Security Act (42 U.S.C. Section 1396 et seq.) and any other
44	44	applicable law or regulation or under a federal waiver or other
45	45	authorization, and subject to Subsection (c), the executive
46	46	commissioner of the Health and Human Services Commission shall
47	47	adopt cost-sharing provisions that encourage personal
48	48	accountability and appropriate utilization of health care
49	49	services.
50	50	(a-1) The executive commissioner of the Health and Human
51	51	Services Commission shall adopt a cost-sharing provision under
52	52	Subsection (a) that requires [require] a recipient who chooses to
53	53	receive a nonemergency [a high-cost] medical service [provided]
54	54	through a hospital emergency room to pay a copayment[, premium
55	55	payment,] or other cost-sharing payment for the nonemergency
56	56	[high-cost] medical service if:
57	57	(1) the hospital from which the recipient seeks
58	58	service:
59	59	(A) performs an appropriate medical screening
60	60	and determines that the recipient does not have a condition
61	61	requiring emergency medical services;
62	62	(B) informs the recipient:
63	63	(i) that the recipient does not have a
64	64	condition requiring emergency medical services;
65	65	(ii) that, if the hospital provides the
66	66	nonemergency medical service, the hospital may require payment of a
67	67	copayment[, premium payment,] or other cost-sharing payment by the
68	68	recipient in advance; and
69	69	(iii) of the name and address of a
70	70	nonemergency Medicaid provider who can provide the appropriate
71	71	medical service without imposing a cost-sharing payment; and
72	72	(C) offers to provide the recipient with a
73	73	referral to the nonemergency provider to facilitate scheduling of
74	74	the service; and
75	75	(2) after receiving the information and assistance
76	76	described by Subdivision (1) from the hospital, the recipient
77	77	chooses to obtain [emergency] medical services through the hospital
78	78	emergency room despite having access to appropriate and medically
79	79	acceptable[, lower-cost] medical services.
80	80	(c) If the executive commissioner of the Health and Human
81	81	Services Commission adopts copayments [a copayment or other
82	82	cost-sharing payment] under Subsection (a) for the following health
83	83	care services, the executive commissioner shall require that a
84	84	recipient pay copayments in the following amounts:
85	85	(1) not more than $5 for each hospital outpatient
86	86	visit at the time of the visit, other than a visit for a
87	87	nonemergency medical service provided through a hospital emergency
88	88	room;
89	89	(2) not more than $5 for each medical visit with a
90	90	physician at the time of the visit; and
91	91	(3) not more than $7.50 per prescription drug
92	92	[commission may not reduce hospital payments to reflect the
93	93	potential receipt of a copayment or other payment from a recipient
94	94	receiving medical services provided through a hospital emergency
95	95	room].
96	96	(d) Subsection (c) does not require a medical assistance
97	97	provider to bill or collect from a recipient a copayment required or
98	98	authorized under this section.
99	99	SECTION 4. If before implementing any provision of this Act
100	100	a state agency determines that a waiver or authorization from a
101	101	federal agency is necessary for implementation of that provision,
102	102	the agency affected by the provision shall request the waiver or
103	103	authorization and may delay implementing that provision until the
104	104	waiver or authorization is granted.
105	105	SECTION 5. This Act takes effect September 1, 2011.