By: Frank, González of El Paso, Noble, H.B. No. 3720
Guillen, Capriglione
A BILL TO BE ENTITLED
AN ACT
relating to interest lists and eligibility criteria for certain
Medicaid waiver programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.06011 and 531.06035 to read as
follows:
Sec. 531.06011. CERTAIN MEDICAID WAIVER PROGRAMS: INTEREST
LIST MANAGEMENT. (a) This section applies only with respect to the
following waiver programs:
(1) the community living assistance and support
services (CLASS) waiver program;
(2) the home and community-based services (HCS) waiver
program;
(3) the deaf-blind with multiple disabilities (DBMD)
waiver program;
(4) the Texas home living (TxHmL) waiver program;
(5) the medically dependent children (MDCP) waiver
program; and
(6) the STAR+PLUS home and community-based services
(HCBS) program.
(b) The commission, in consultation with the Intellectual
and Developmental Disability System Redesign Advisory Committee
established under Section 534.053, the state Medicaid managed care
advisory committee, and interested stakeholders, shall develop a
questionnaire to be completed by or on behalf of an individual who
requests to be placed on or is currently on an interest list for a
waiver program.
(c) The questionnaire developed under Subsection (b) must,
at a minimum, request the following information about an individual
seeking or receiving services under a waiver program:
(1) contact information for the individual or the
individual's parent or other legally authorized representative;
(2) the individual's general demographic information;
(3) the individual's living arrangement;
(4) the types of assistance the individual requires;
(5) the individual's current caregiver supports and
circumstances that may cause the individual to lose those supports;
and
(6) when the delivery of services under a waiver
program should begin to ensure the individual's health and welfare
and that the individual receives services and supports in the least
restrictive setting possible.
(d) Subject to the availability of funds, the commission
shall require all individuals on an interest list to annually
update the questionnaire developed under Subsection (b).
(e) If the commission determines that it is feasible, the
commission shall develop an online portal to allow an individual or
an individual's parent or other legally authorized representative
to:
(1) request placement on a waiver program interest
list; and
(2) complete and update the questionnaire developed
under Subsection (b).
(f) If an individual is on a waiver program's interest list
and the individual or the individual's parent or other legally
authorized representative does not respond to a written or verbal
request made by the commission to update information concerning the
individual or otherwise fails to maintain contact with the
commission, the commission:
(1) shall designate the individual's status on the
interest list as inactive until the individual or the individual's
parent or other legally authorized representative notifies the
commission that the individual is still interested in receiving
services under the waiver program; and
(2) at the time the individual or the individual's
parent or other legally authorized representative provides notice
to the commission under Subdivision (1), shall designate the
individual's status on the interest list as active and restore the
individual to the position on the list that corresponds with the
date the individual was initially placed on the list.
(g) The commission's designation of an individual's status
on an interest list as inactive under Subsection (f) may not result
in the removal of the individual from that list or any other waiver
program interest list.
(h) Not later than September 1 of each year, the commission
shall provide to the Intellectual and Developmental Disability
System Redesign Advisory Committee established under Section
534.053, or, if that advisory committee is abolished, an
appropriate stakeholder advisory committee, as determined by the
executive commissioner, the number of individuals, including
individuals whose status is designated as inactive by the
commission, who are on an interest list to receive services under a
waiver program.
Sec. 531.06035. MEDICALLY DEPENDENT CHILDREN WAIVER
PROGRAM (MDCP) INTEREST LIST; MEDICAL NECESSITY ASSESSMENT
REQUIRED. (a) This section applies only to a child who receives
Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et
seq.).
(b) If a child's parent or other legally authorized
representative expresses interest in placing the child on the
interest list for the medically dependent children (MDCP) waiver
program, the commission shall conduct a medical necessity
assessment of the child to ensure the child is eligible for services
before placing the child on the program's interest list.
SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0521 to read as follows:
Sec. 32.0521. ELIGIBILITY FOR TEXAS HOME LIVING (TxHmL)
WAIVER PROGRAM. (a) In this section:
(1) "Related condition" means, consistent with 42
C.F.R. Section 435.1010, a severe and chronic disability that:
(A) is attributed to:
(i) cerebral palsy or epilepsy; or
(ii) any other condition, other than mental
illness, found to be closely related to intellectual disability
because the condition results in impairment of general intellectual
functioning or adaptive behavior similar to that of individuals
with intellectual disability, and requires treatment or services
similar to those required for individuals with intellectual
disability;
(B) is manifested before the individual reaches
22 years of age;
(C) is likely to continue indefinitely; and
(D) results in substantial functional limitation
in at least three of the following areas of major life activity:
(i) self-care;
(ii) understanding and use of language;
(iii) learning;
(iv) mobility;
(v) self-direction; and
(vi) capacity for independent living.
(2) "Section 1915(c) waiver program" has the meaning
assigned by Section 531.001, Government Code.
(b) To the extent allowed by federal law, an individual is
financially eligible to participate in the Texas home living
(TxHmL) waiver program if the individual's income is not more than
the special income limit established by the commission for other
Section 1915(c) waiver programs, including the home and
community-based services (HCS) waiver program.
(c) To the extent permitted by federal law, the commission
shall expand medical eligibility criteria under the Texas home
living (TxHmL) waiver program to ensure that an individual is
medically eligible to participate in the waiver program if the
individual:
(1) has a primary diagnosis by a licensed physician of
a related condition that is included on the list of diagnostic codes
for persons with related conditions that are approved by the
commission; and
(2) has moderate to extreme deficits in adaptive
behavior, as determined by commission rule, obtained by
administering a standardized assessment of adaptive behavior.
SECTION 3. As soon as practicable after the effective date
of this Act, the Health and Human Services Commission shall:
(1) develop the questionnaire required by Section
531.06011(b), Government Code, as added by this Act, and, subject
to the availability of funds, implement Subsection (d) of that
section not later than September 1, 2024;
(2) determine the feasibility of developing an online
portal under Section 531.06011(e), Government Code, as added by
this Act, and if feasible, develop and implement the online portal;
and
(3) as appropriate, conduct a medical necessity
assessment of each child who is on the interest list for the
medically dependent children (MDCP) waiver program on the effective
date of this Act to ensure the child's eligibility for program
services.
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, 2021.