84R21921 EES-D
By: Naishtat H.B. No. 839
Substitute the following for H.B. No. 839:
By: Crownover C.S.H.B. No. 839
A BILL TO BE ENTITLED
AN ACT
relating to presumptive eligibility for Medicaid and the child
health plan program for certain children.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 62.101, Health and Safety Code, is
amended by adding Subsections (d) and (e) to read as follows:
(d) As authorized by 42 U.S.C. Section 1397gg, the executive
commissioner shall adopt rules providing for the determination and
certification of presumptive eligibility for the child health plan
program of a child under 19 years of age who applies for and meets
the basic eligibility requirements for the child health plan
program.
(e) The rules adopted under Subsection (d) must:
(1) allow only a juvenile facility for the placement,
detention, or commitment of a child under Title 3, Family Code, to
serve as a qualified entity and make a presumptive eligibility
determination for the child health plan program for a child; and
(2) identify the services and benefits, which must
include mental health and substance abuse services, prescription
drug benefits, and primary care services, that a child who is
presumptively eligible for the child health plan program may
receive under that program.
SECTION 2. Section 62.154(b), Health and Safety Code, as
amended by S.B. No. 219, Acts of the 84th Legislature, Regular
Session, 2015, is amended to read as follows:
(b) A child is not subject to a waiting period adopted under
Subsection (a) if:
(1) the family lost coverage for the child as a result
of:
(A) termination of employment because of a layoff
or business closing;
(B) termination of continuation coverage under
the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L.
No. 99-272);
(C) change in marital status of a parent of the
child;
(D) termination of the child's Medicaid
eligibility because:
(i) the child's family's earnings or
resources increased; or
(ii) the child reached an age at which
Medicaid coverage is not available; or
(E) a similar circumstance resulting in the
involuntary loss of coverage;
(2) the family terminated health benefits plan
coverage for the child because the cost to the child's family for
the coverage exceeded 9.5 percent of the family's household income;
(3) the child has access to group-based health
benefits plan coverage and is required to participate in the health
insurance premium payment reimbursement program administered by
the commission;
(4) the child is certified as presumptively eligible
for the child health plan program under rules adopted under Section
62.101(d);
(5) the commission has determined that other grounds
exist for a good cause exception; or
(6) [(5)] federal law provides that the child is not
subject to a waiting period adopted under Subsection (a).
SECTION 3. Section 32.026, Human Resources Code, is amended
by adding Subsections (h), (i), and (j) to read as follows:
(h) As authorized by 42 U.S.C. Section 1396r-1a, the
executive commissioner shall adopt rules providing for the
determination and certification of presumptive eligibility for
medical assistance for a child under 19 years of age who applies for
and meets the basic eligibility requirements for medical
assistance.
(i) The rules adopted under Subsection (h) must:
(1) allow only a juvenile facility for the placement,
detention, or commitment of a child under Title 3, Family Code, to
serve as a qualified entity and make a presumptive eligibility
determination for the medical assistance program for a child,
unless the presumptive eligibility determination is being made in
accordance with rules adopted under Subsection (b) or Section
32.024(y), or in accordance with 42 U.S.C. Section 1396a(a)(47);
and
(2) identify the services and benefits, which must
include mental health and substance abuse services, prescription
drug benefits, and primary care services, that a child who is
presumptively eligible for medical assistance may receive under the
medical assistance program.
(j) Subsections (h) and (i) do not affect the presumptive
eligibility of a person under Subsection (b), Section 32.024(y), or
42 U.S.C. Section 1396a(a)(47), including an authorized person's
ability to make a presumptive eligibility determination under the
medical assistance program or an applicant's eligibility under
those provisions.
SECTION 4. The executive commissioner of the Health and
Human Services Commission shall adopt the rules required by Section
62.101(d), Health and Safety Code, as added by this Act, and Section
32.026(h), Human Resources Code, as added by this Act, not later
than January 1, 2016.
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, 2015.