83R9597 EES-F
By: Villarreal H.B. No. 3487
A BILL TO BE ENTITLED
AN ACT
relating to expanding eligibility for medical assistance to certain
persons under the federal Patient Protection and Affordable Care
Act and ensuring the provision of quality care under and the
effectiveness of the medical assistance program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 32, Human Resources Code, is amended by
adding Subchapter H to read as follows:
SUBCHAPTER H. EXPANSION OF ELIGIBILITY FOR MEDICAL ASSISTANCE
Sec. 32.351. DEFINITIONS. In this subchapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
(3) "Medical assistance expansion group" means the
category of persons who would not be eligible for medical
assistance under the eligibility criteria in effect on December 31,
2013, but who are eligible for that assistance because of the
requirement of Section 32.352(a).
(4) "Undocumented immigrant" means a person who:
(A) is not a citizen or other national of the
United States; and
(B) is not lawfully authorized to be present in
the United States under the Immigration and Nationality Act (8
U.S.C. Section 1101 et seq.) or other federal law.
Sec. 32.352. EXPANDED ELIGIBILITY FOR MEDICAL ASSISTANCE
UNDER PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a)
Notwithstanding any other law and except as provided in Subsection
(b) and Section 32.353, to the extent funds are appropriated to the
commission for that purpose, the commission shall provide medical
assistance to all persons who apply for that assistance and for whom
federal matching funds are available under the Patient Protection
and Affordable Care Act (Pub. L. No. 111-148) as amended by the
Health Care and Education Reconciliation Act of 2010 (Pub. L. No.
111-152) to provide that assistance.
(b) Nothing in this section authorizes the commission to
provide medical assistance to undocumented immigrants.
(c) The executive commissioner shall adopt rules regarding
the provision of medical assistance as required by this section.
Sec. 32.353. RESTRICTED ELIGIBILITY FOR MEDICAL ASSISTANCE
UPON CHANGES IN FEDERAL MATCHING FUNDS. (a) Notwithstanding any
other law, if the federal medical assistance percentage (FMAP) by
which this state's expenditures under the medical assistance
program are matched with federal funds and that applies with
respect to persons in the medical assistance expansion group is
less than the percentage provided for in the Patient Protection and
Affordable Care Act (Pub. L. No. 111-148) as amended by the Health
Care and Education Reconciliation Act of 2010 (Pub. L. No.
111-152), and excluding subsequent amendments:
(1) the commission shall alert the Legislative Budget
Board; and
(2) beginning on the first day of the month following
the month in which the new federal medical assistance percentage
(FMAP) becomes effective, the commission shall:
(A) cease providing medical assistance to
persons in the medical assistance expansion group; and
(B) reinstate the eligibility criteria for
medical assistance that existed on December 31, 2013.
(b) The executive commissioner shall adopt any rules
necessary to implement any changes in the provision of and
eligibility criteria for medical assistance required by this
section.
Sec. 32.354. FEDERAL AUTHORIZATION FOR IMPLEMENTATION OF
COST-SHARING OBLIGATIONS FOR MEDICAL ASSISTANCE EXPANSION GROUP.
The executive commissioner shall seek a waiver or other appropriate
authorization from the appropriate federal agency to develop and
implement cost-sharing obligations for the medical assistance
expansion group. Cost-sharing obligations developed by the
commission under this section:
(1) must be designed to:
(A) incentivize persons in the medical
assistance expansion group to seek preventive or routine health
care services, rather than emergency health care services, when
possible and appropriate; and
(B) guarantee quality health care for persons in
the medical assistance expansion group;
(2) may include:
(A) copayments and deductibles; and
(B) modifications to the reimbursement
methodologies for services provided to persons in the medical
assistance expansion group; and
(3) may incorporate any other incentives or strategies
that the commission determines are necessary.
Sec. 32.355. ANNUAL REPORT ON EXPANDED ELIGIBILITY FOR
MEDICAL ASSISTANCE. Not later than December 1 of each year, the
commission shall report to the governor, the lieutenant governor,
the speaker of the house of representatives, and the standing
committees of the senate and the house of representatives having
primary jurisdiction over the medical assistance program on the
effects of expanding eligibility for medical assistance under
Section 32.352, including the effects on:
(1) the number of persons in this state who do not have
health benefits coverage;
(2) state health care costs, including costs relating
to programs funded with money appropriated out of the general
revenue fund;
(3) local health care costs; and
(4) charity care and uncompensated care costs for
hospitals.
SECTION 2. Section 32.352, Human Resources Code, as added
by this Act, applies only to an initial determination or
recertification of eligibility of a person for medical assistance
under Chapter 32, Human Resources Code, made on or after January 1,
2014, regardless of the date the person applied for that
assistance.
SECTION 3. As soon as possible after the effective date of
this Act, the executive commissioner of the Health and Human
Services Commission shall take all necessary actions to expand
eligibility for medical assistance under Chapter 32, Human
Resources Code, beginning January 1, 2014, and in accordance with
Section 32.352, Human Resources Code, as added by this Act,
including:
(1) notifying appropriate federal agencies of that
expanded eligibility; and
(2) establishing work groups or consulting with
stakeholder groups.
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 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, 2013.