86R3390 LED-D
By: Martinez H.B. No. 1016
A BILL TO BE ENTITLED
AN ACT
relating to eligibility determinations for the STAR+PLUS home and
community based services (HCBS) program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.00282 to read as follows:
Sec. 533.00282. ELIGIBILITY DETERMINATIONS FOR STAR+PLUS
HOME AND COMMUNITY BASED SERVICES (HCBS) PROGRAM. (a) The
commission shall determine Medicaid eligibility for an applicant
for the STAR+PLUS home and community based services (HCBS) program
not later than:
(1) the 20th day after the date the applicant submits
the application; or
(2) the 45th day after the date the applicant submits
the application, if the applicant is applying on the basis of a
disability.
(b) A managed care organization with which the commission
contracts to provide health care services to recipients shall, not
later than the 30th day after the date an applicant for the
STAR+PLUS home and community based services (HCBS) program submits
the application, complete and submit to the entity serving as this
state's Medicaid claims administrator the applicant's:
(1) individual service plan; and
(2) medical necessity and level of care assessment.
SECTION 2. Section 533.00282(a), Government Code, as added
by this Act, applies only to an application for a determination of
Medicaid eligibility submitted on or after the effective date of
this Act. An application for a determination of Medicaid
eligibility submitted before the effective date of this Act is
governed by the law in effect immediately before the effective date
of this Act, and that law is continued in effect for that purpose.
SECTION 3. (a) The Health and Human Services Commission
shall, in a contract between the commission and a managed care
organization under Chapter 533, Government Code, that is entered
into or renewed on or after the effective date of this Act, require
that the managed care organization comply with Section
533.00282(b), Government Code, as added by this Act.
(b) The Health and Human Services Commission shall seek to
amend contracts entered into with managed care organizations under
Chapter 533, Government Code, before the effective date of this Act
to require those managed care organizations to comply with Section
533.00282(b), Government Code, as added by this Act. To the extent
of a conflict between Section 533.00282(b), Government Code, as
added by this Act, and a provision of a contract with a managed care
organization entered into before the effective date of this Act,
the contract provision prevails.
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, 2019.