Texas 2021 - 87th Regular

Texas House Bill HB4311 Compare Versions

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

Old	New	Differences
1	1	87R12431 KKR-D
2	2	By: Bucy H.B. No. 4311
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to establishing an assistance program to provide certain
8	8	health care services to certain medically fragile children.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle C, Title 2, Human Resources Code, is
11	11	amended by adding Chapter 37 to read as follows:
12	12	CHAPTER 37. MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM
13	13	Sec. 37.001. DEFINITIONS. In this chapter:
14	14	(1) "Child health plan program" means the child health
15	15	plan program established under Chapters 62 and 63, Health and
16	16	Safety Code.
17	17	(2) "Medicaid" means the medical assistance program
18	18	established under Chapter 32.
19	19	(3) "Medically fragile child" means a person younger
20	20	than 21 years of age who is:
21	21	(A) chronically ill or disabled and requires
22	22	indefinite skilled nursing care to maintain the person's existence
23	23	in the person's home;
24	24	(B) temporarily ill or disabled because of
25	25	premature birth, accident, or trauma and has experienced a
26	26	temporary lifestyle change requiring skilled nursing care;
27	27	(C) suffering from uncontrollable seizures or
28	28	other chronic illness; or
29	29	(D) chronically dependent on medical devices to
30	30	perform vital bodily functions.
31	31	(4) "Program" means the program to provide health care
32	32	services to medically fragile children established under Section
33	33	37.002.
34	34	(5) "Wrap-around benefits" means a service, including
35	35	a pharmacy or medical benefit:
36	36	(A) not covered under a private health benefit
37	37	plan or a public benefit program, including Medicaid and the child
38	38	health plan program, in which the child is enrolled; or
39	39	(B) covered under a private health benefit plan
40	40	in which the child is enrolled but the child has exceeded the
41	41	private health benefit plan coverage limit.
42	42	Sec. 37.002. ESTABLISHMENT OF PROGRAM. The commission,
43	43	exclusive of Medicaid, by rule shall develop and implement a
44	44	program under which health care services are provided to medically
45	45	fragile children with a rare and unique disease or medical
46	46	condition. The program must:
47	47	(1) provide benefits based on a child's diagnosis; and
48	48	(2) be designed to provide wrap-around benefits to
49	49	children participating in the program.
50	50	Sec. 37.003. ELIGIBLE CHILDREN. (a) The executive
51	51	commissioner by rule shall identify the diagnoses considered rare
52	52	and unique for purposes of determining eligibility under the
53	53	program.
54	54	(b) The executive commissioner may not impose income
55	55	eligibility requirements under the program.
56	56	Sec. 37.004. COVERED HEALTH CARE SERVICES. (a) Eligible
57	57	health care services under the program must include:
58	58	(1) specialized nutritional support, including
59	59	enteral nutrition;
60	60	(2) physical or occupational therapy;
61	61	(3) speech therapy;
62	62	(4) music therapy;
63	63	(5) aqua-therapy;
64	64	(6) hippotherapy;
65	65	(7) private duty nursing services in home or
66	66	educational environments;
67	67	(8) chiropractic services; and
68	68	(9) any other health care service or therapy the
69	69	commission determines necessary.
70	70	(b) To receive services under the program, the executive
71	71	commissioner may require that a participant provide evidence:
72	72	(1) from a health care provider that the proposed
73	73	services are medically necessary; and
74	74	(2) if the participant has private health benefit plan
75	75	coverage, that:
76	76	(A) the service is not covered under the plan;
77	77	(B) the issuer has denied coverage under the
78	78	plan; or
79	79	(C) the participant has met the applicable
80	80	coverage limit under the plan.
81	81	Sec. 37.005. MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM
82	82	ACCOUNT. (a) The medically fragile children assistance program
83	83	account is an account in the general revenue fund.
84	84	(b) The account consists of:
85	85	(1) appropriations of money to the account by the
86	86	legislature;
87	87	(2) gifts, grants, including federal grants, and other
88	88	donations received under Section 37.006; and
89	89	(3) interest earned on the investment of money in the
90	90	account.
91	91	(c) Money in the account may be appropriated only to the
92	92	commission for purposes of the program.
93	93	Sec. 37.006. GIFTS, GRANTS, AND DONATIONS. The commission
94	94	may accept gifts, grants, and donations from any source that are
95	95	made for the purposes of the program. The commission shall deposit
96	96	money received under this section to the credit of the medically
97	97	fragile children assistance program account.
98	98	SECTION 2. Not later than January 1, 2022, the Health and
99	99	Human Services Commission shall establish the program to provide
100	100	health care services to medically fragile children established
101	101	under Section 37.002, Human Resources Code, as added by this Act.
102	102	SECTION 3. This Act takes effect September 1, 2021.