By: Zaffirini S.B. No. 29
A BILL TO BE ENTITLED
AN ACT
relating to certain Medicaid home and community-based services
waiver programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Sections 32.0521 and 32.0522 to read as
follows:
Sec. 32.0521. MEDICALLY FRAGILE WAIVER PROGRAM FOR
MEDICALLY FRAGILE INDIVIDUALS. (a) The department shall develop
and apply for a waiver under Section 1915(c), Social Security Act
(42 U.S.C. Section 1396n(c)), to provide the state with the
flexibility to provide medical assistance services outside the
scope, amount, or duration of nonwaiver services available to
medically fragile individuals who are at least 21 years of age and
who require a hospital level of care under the medical assistance
program.
(b) The medically fragile waiver program under this section
must include coverage for:
(1) advanced supportive and restorative services;
(2) case management services;
(3) environmental modifications;
(4) home-delivered meals;
(5) hospice care;
(6) occupational therapy;
(7) personal care;
(8) prescribed drugs;
(9) personal emergency response systems;
(10) physical therapy;
(11) private duty nursing;
(12) respiratory therapy;
(13) respite care;
(14) skilled nursing;
(15) specialized medical equipment and supplies; and
(16) speech therapy.
(c) The department may not require that a medically fragile
or technology-dependent individual who meets the eligibility
criteria for the medically fragile waiver program be placed in an
alternative institutional living arrangement as a condition for
receiving services under the medicaid program.
(d) To ensure that services subject to this section are cost
neutral and not duplicative of other services provided under the
medical assistance program, the department shall coordinate the
provision of services subject to this section with services
provided under other federal waiver programs.
Sec. 32.0522. LEVELS OF NEED IN HOME AND COMMUNITY-BASED
SERVICES WAIVER PROGRAM. (a) The department shall develop and
apply for a waiver amendment under Section 1915(c), Social Security
Act (42 U.S.C. Section 1396n(c)), to establish a level of need for
use in the Home and Community-based Services waiver program to
assess individuals who are at least 21 years of age and may require
continuous, intensive, and specialized medical support to ensure
that those individuals may receive that support.
(b) The individual cost limit for an individual assigned the
level of need established under this section must be equal to or
greater than the individual cost limit for an individual assigned a
level of need that includes the receipt of the most intensive
behavioral health support under the Home and Community-based
Services waiver program.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver, an amendment to an existing
waiver, or another authorization from a federal agency is necessary
for implementation of that provision, the agency affected by the
provision shall request the waiver, amendment to the existing
waiver, or other authorization and may delay implementing that
provision until the waiver, amendment, or authorization is granted.
SECTION 3. This Act takes effect September 1, 2013.