By: Guillen, Raymond, Klick H.B. No. 2474
A BILL TO BE ENTITLED
AN ACT
relating to the continuation of medical assistance for certain
individuals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.0256, Human Resources Code, is
amended to read as follows:
Sec. 32.0256. CONTINUATION OF MEDICAL ASSISTANCE FOR
CERTAIN INDIVIDUALS; ANNUAL REPORT. (a) A recipient [described by
Section 32.025(a)] who experiences an event or circumstance,
including a temporary increase in income of a duration of one month
or less or a minor technical or clerical error committed on or with
respect to the recipient's renewal application or other document
required for benefits renewal, that would normally result in the
recipient being determined ineligible for medical assistance
continues to be eligible for that assistance if the individual:
(1) either:
(A) receives services through one of the
following programs that serve [a program for] individuals with an
intellectual or developmental disability [authorized] under
Section 1915(c), Social Security Act (42 U.S.C. Section 1396n(c)):
(i) the home and community-based services
(HCS) waiver program; or
(ii) the Texas home living (TxHmL) waiver
program; or
(B) resides in an ICF-IID facility; and
(2) continues to meet the functional and diagnostic
criteria for the receipt of services under a program described by
Subdivision (1)(A) or for residency in an ICF-IID facility.
(b) To continue to be eligible for medical assistance, a
recipient described by Subsection (a) who is determined ineligible
for medical assistance because of an event or circumstance caused
wholly by the action or inaction of the recipient or the recipient's
parent or guardian must submit an application for medical
assistance in accordance with Section 32.025(b) not later than the
90th day after the date on which the recipient is determined
ineligible.
(c) The commission may not suspend or terminate the
eligibility of a recipient for medical assistance benefits if the
recipient's ineligibility is caused partly or wholly by a technical
or clerical error committed by the commission or an agent of the
commission.
(d) The commission shall:
(1) coordinate with and inform relevant health care
providers if a recipient described by Subsection (a) is at risk of
being determined ineligible for medical assistance benefits or is
determined ineligible for those benefits; and
(2) make reasonable efforts to ensure the medical
assistance benefits of a recipient described by Subsection (a) are
not suspended or terminated.
(e) Not later than December 31 of each year, the commission
shall prepare and submit a report to the legislature regarding the
suspension or termination of medical assistance benefits of
recipients described by Subsection (a) that occurred during the
preceding state fiscal year. The report must include:
(1) the number of recipients who are living in a
community-based, residential setting whose eligibility for
benefits was suspended or terminated during each month of the
fiscal year;
(2) if the commission reinstated the benefits of a
recipient, the average, median, shortest, and longest length of
time the commission took to reinstate those benefits;
(3) the number of recipients whose benefits were not
reinstated by the commission;
(4) the specific reason for the suspension or
termination of benefits of a recipient, including an analysis of
the percentage of suspensions or terminations related to:
(A) an increase in the recipient's income;
(B) a failure by the recipient or the recipient's
parent or guardian to properly submit a renewal application or
other document required for benefits renewal;
(C) a change in the recipient's condition that
results in the recipient no longer meeting the functional or
diagnostic criteria necessary to establish the recipient's
eligibility for services under a program described by Subsection
(a)(1)(A) or for residency in an ICF-IID facility;
(D) a technical or clerical error committed by
the commission or an agent of the commission; and
(E) any other reason that occurs with enough
frequency to warrant its inclusion in the analysis, as determined
by the commission; and
(5) a statement of the amount of retroactive
reimbursements paid to health care providers for the provision of
services to a recipient during the time the recipient's eligibility
for benefits was suspended or terminated.
SECTION 2. Section 3, Chapter 1072 (H.B. 3292), Acts of the
85th Legislature, Regular Session, 2017, is repealed.
SECTION 3. Notwithstanding Section 32.0256(e), Human
Resources Code, as added by this Act, the Health and Human Services
Commission shall ensure that the initial report required under that
subsection includes a description of the number of recipients
described by Section 32.0256(a), Human Resources Code, as amended
by this Act, who are living in a community-based, residential
setting and whose eligibility for benefits was suspended or
terminated during each month of the state fiscal years ending
August 31, 2016, August 31, 2017, and August 31, 2018.
SECTION 4. (a) As soon as practicable after the effective
date of this Act, the Health and Human Services Commission shall
conduct a review of the commission's policies and processes
relating to the renewal of Medicaid benefits for the following
Medicaid recipients:
(1) persons receiving services through one of the
following Medicaid programs authorized under Section 1915(c) of the
federal Social Security Act (42 U.S.C. Section 1396n(c)) that
provide services to persons with an intellectual or developmental
disability:
(A) the home and community-based services (HCS)
waiver program; or
(B) the Texas home living (TxHmL) waiver program;
and
(2) persons residing in an ICF-IID facility.
(b) In conducting the review under this section, the Health
and Human Services Commission shall:
(1) analyze existing data relating to:
(A) the number of Medicaid recipients who lost
eligibility for Medicaid benefits during each month of the state
fiscal years ending August 31, 2016, August 31, 2017, and August 31,
2018; and
(B) the reasons for those recipients' loss of
eligibility, including because of minor technical or clerical
errors made on or with respect to a renewal application or other
document required to renew eligibility for the benefits;
(2) evaluate the impact recipients' temporary loss of
benefits has on the recipients and health care providers; and
(3) identify best practices for the commission,
recipients and their legally authorized representatives, and
health care providers to minimize recipients' loss of eligibility
for the benefits because of:
(A) minor technical or clerical errors made on or
with respect to a renewal application or other document required to
renew eligibility for the benefits; or
(B) the recipient's failure to provide
information necessary to renew eligibility for the benefits.
(c) Based on the findings of the review conducted under this
section, the Health and Human Services Commission shall, in
consultation with relevant stakeholders, develop a plan to
implement best practices and address barriers to timely renewal of
eligibility for Medicaid benefits and continuation of services for
Medicaid recipients described by Subsection (a) of this section.
The plan must specifically identify best practices for avoiding
loss of eligibility for Medicaid benefits by those recipients
because of minor technical or clerical errors made on or with
respect to a renewal application or other document required to
renew eligibility for the benefits.
(d) Not later than November 1, 2020, the Health and Human
Services Commission shall submit to the legislature the plan
developed under Subsection (c) of this section. The plan must
include:
(1) a summary of issues identified by the commission's
review of policies and processes under this section;
(2) a timeline for the commission's implementation of
the best practices identified for implementation in the review; and
(3) recommendations for potential legislation if the
commission determines that changes in statute are required to
address issues identified in the review.
(e) This section expires September 1, 2021.
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, 2019.