Texas 2021 - 87th Regular

Texas House Bill HB3761 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	87R8496 KFF-F
2	2	By: Guillen H.B. No. 3761
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the continuation of medical assistance for certain
8	8	individuals.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 32.0256, Human Resources Code, is
11	11	amended to read as follows:
12	12	Sec. 32.0256. CONTINUATION OF MEDICAL ASSISTANCE FOR
13	13	CERTAIN INDIVIDUALS; ANNUAL REPORT. (a) A recipient [described by
14	14	Section 32.025(a)] who experiences an event or circumstance,
15	15	including a temporary increase in income of a duration of one month
16	16	or less or a minor technical or clerical error committed on or with
17	17	respect to the recipient's renewal application or other document
18	18	required for benefits renewal, that would normally result in the
19	19	recipient being determined ineligible for medical assistance
20	20	continues to be eligible for that assistance if the individual:
21	21	(1) either:
22	22	(A) receives services through one of the
23	23	following programs that serve [a program for] individuals with an
24	24	intellectual or developmental disability [authorized] under
25	25	Section 1915(c), Social Security Act (42 U.S.C. Section 1396n(c)):
26	26	(i) the home and community-based services
27	27	(HCS) waiver program; or
28	28	(ii) the Texas home living (TxHmL) waiver
29	29	program; or
30	30	(B) resides in an ICF-IID facility; and
31	31	(2) continues to meet the functional and diagnostic
32	32	criteria for the receipt of services under a program described by
33	33	Subdivision (1)(A) or for residency in an ICF-IID facility.
34	34	(b) To continue to be eligible for medical assistance, a
35	35	recipient described by Subsection (a) who is determined ineligible
36	36	for medical assistance because of an event or circumstance caused
37	37	wholly by the action or inaction of the recipient or the recipient's
38	38	parent or guardian must submit an application for medical
39	39	assistance in accordance with Section 32.025(b) not later than the
40	40	90th day after the date on which the recipient is determined
41	41	ineligible.
42	42	(c) The commission may not suspend or terminate the
43	43	eligibility of a recipient for medical assistance benefits if the
44	44	recipient's ineligibility is caused partly or wholly by a technical
45	45	or clerical error committed by the commission or an agent of the
46	46	commission.
47	47	(d) The commission shall:
48	48	(1) coordinate with and inform relevant health care
49	49	providers if a recipient described by Subsection (a) is at risk of
50	50	being determined ineligible for medical assistance benefits or is
51	51	determined ineligible for those benefits; and
52	52	(2) make reasonable efforts to ensure the medical
53	53	assistance benefits of a recipient described by Subsection (a) are
54	54	not suspended or terminated.
55	55	(e) Not later than December 31 of each year, the commission
56	56	shall prepare and submit a report to the legislature regarding the
57	57	suspension or termination of medical assistance benefits of
58	58	recipients described by Subsection (a) that occurred during the
59	59	preceding state fiscal year. The report must include:
60	60	(1) the number of recipients who are living in a
61	61	community-based, residential setting whose eligibility for
62	62	benefits was suspended or terminated during each month of the
63	63	fiscal year;
64	64	(2) if the commission reinstated the benefits of a
65	65	recipient, the average, median, shortest, and longest length of
66	66	time the commission took to reinstate those benefits;
67	67	(3) the number of recipients whose benefits were not
68	68	reinstated by the commission;
69	69	(4) the specific reason for the suspension or
70	70	termination of benefits of a recipient, including an analysis of
71	71	the percentage of suspensions or terminations related to:
72	72	(A) an increase in the recipient's income;
73	73	(B) a failure by the recipient or the recipient's
74	74	parent or guardian to properly submit a renewal application or
75	75	other document required for benefits renewal;
76	76	(C) a change in the recipient's condition that
77	77	results in the recipient no longer meeting the functional or
78	78	diagnostic criteria necessary to establish the recipient's
79	79	eligibility for services under a program described by Subsection
80	80	(a)(1)(A) or for residency in an ICF-IID facility;
81	81	(D) a technical or clerical error committed by
82	82	the commission or an agent of the commission; and
83	83	(E) any other reason that occurs with enough
84	84	frequency to warrant its inclusion in the analysis, as determined
85	85	by the commission; and
86	86	(5) a statement of the amount of retroactive
87	87	reimbursements paid to health care providers for the provision of
88	88	services to a recipient during the time the recipient's eligibility
89	89	for benefits was suspended or terminated.
90	90	SECTION 2. Section 3, Chapter 1072 (H.B. 3292), Acts of the
91	91	85th Legislature, Regular Session, 2017, is repealed.
92	92	SECTION 3. Notwithstanding Section 32.0256(e), Human
93	93	Resources Code, as added by this Act, the Health and Human Services
94	94	Commission shall ensure that the initial report required under that
95	95	subsection includes a description of the number of recipients
96	96	described by Section 32.0256(a), Human Resources Code, as amended
97	97	by this Act, who are living in a community-based, residential
98	98	setting and whose eligibility for benefits was suspended or
99	99	terminated during each month of the state fiscal years ending
100	100	August 31, 2016, August 31, 2017, August 31, 2018, and August 31,
101	101	2019.
102	102	SECTION 4. (a) As soon as practicable after the effective
103	103	date of this Act, the Health and Human Services Commission shall
104	104	conduct a review of the commission's policies and processes
105	105	relating to the renewal of Medicaid benefits for the following
106	106	Medicaid recipients:
107	107	(1) persons receiving services through one of the
108	108	following Medicaid programs authorized under Section 1915(c) of the
109	109	federal Social Security Act (42 U.S.C. Section 1396n(c)) that
110	110	provide services to persons with an intellectual or developmental
111	111	disability:
112	112	(A) the home and community-based services (HCS)
113	113	waiver program; or
114	114	(B) the Texas home living (TxHmL) waiver program;
115	115	and
116	116	(2) persons residing in an ICF-IID facility.
117	117	(b) In conducting the review under this section, the Health
118	118	and Human Services Commission shall:
119	119	(1) analyze existing data relating to:
120	120	(A) the number of Medicaid recipients who lost
121	121	eligibility for Medicaid benefits during each month of the state
122	122	fiscal years ending August 31, 2016, August 31, 2017, August 31,
123	123	2018, and August 31, 2019; and
124	124	(B) the reasons for those recipients' loss of
125	125	eligibility, including because of minor technical or clerical
126	126	errors made on or with respect to a renewal application or other
127	127	document required to renew eligibility for the benefits;
128	128	(2) evaluate the impact recipients' temporary loss of
129	129	benefits has on the recipients and health care providers; and
130	130	(3) identify best practices for the commission,
131	131	recipients and their legally authorized representatives, and
132	132	health care providers to minimize recipients' loss of eligibility
133	133	for the benefits because of:
134	134	(A) minor technical or clerical errors made on or
135	135	with respect to a renewal application or other document required to
136	136	renew eligibility for the benefits; or
137	137	(B) the recipient's failure to provide
138	138	information necessary to renew eligibility for the benefits.
139	139	(c) Based on the findings of the review conducted under this
140	140	section, the Health and Human Services Commission shall, in
141	141	consultation with relevant stakeholders, develop a plan to
142	142	implement best practices and address barriers to timely renewal of
143	143	eligibility for Medicaid benefits and continuation of services for
144	144	Medicaid recipients described by Subsection (a) of this section.
145	145	The plan must specifically identify best practices for avoiding
146	146	loss of eligibility for Medicaid benefits by those recipients
147	147	because of minor technical or clerical errors made on or with
148	148	respect to a renewal application or other document required to
149	149	renew eligibility for the benefits.
150	150	(d) Not later than November 1, 2022, the Health and Human
151	151	Services Commission shall submit to the legislature the plan
152	152	developed under Subsection (c) of this section. The plan must
153	153	include:
154	154	(1) a summary of issues identified by the commission's
155	155	review of policies and processes under this section;
156	156	(2) a timeline for the commission's implementation of
157	157	the best practices identified for implementation in the review; and
158	158	(3) recommendations for potential legislation if the
159	159	commission determines that changes in statute are required to
160	160	address issues identified in the review.
161	161	(e) This section expires September 1, 2023.
162	162	SECTION 5. If before implementing any provision of this Act
163	163	a state agency determines that a waiver or authorization from a
164	164	federal agency is necessary for implementation of that provision,
165	165	the agency affected by the provision shall request the waiver or
166	166	authorization and may delay implementing that provision until the
167	167	waiver or authorization is granted.
168	168	SECTION 6. This Act takes effect immediately if it receives
169	169	a vote of two-thirds of all the members elected to each house, as
170	170	provided by Section 39, Article III, Texas Constitution. If this
171	171	Act does not receive the vote necessary for immediate effect, this
172	172	Act takes effect September 1, 2021.