87R12431 KKR-D
By: Bucy H.B. No. 4311
A BILL TO BE ENTITLED
AN ACT
relating to establishing an assistance program to provide certain
health care services to certain medically fragile children.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle C, Title 2, Human Resources Code, is
amended by adding Chapter 37 to read as follows:
CHAPTER 37. MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM
Sec. 37.001. DEFINITIONS. In this chapter:
(1) "Child health plan program" means the child health
plan program established under Chapters 62 and 63, Health and
Safety Code.
(2) "Medicaid" means the medical assistance program
established under Chapter 32.
(3) "Medically fragile child" means a person younger
than 21 years of age who is:
(A) chronically ill or disabled and requires
indefinite skilled nursing care to maintain the person's existence
in the person's home;
(B) temporarily ill or disabled because of
premature birth, accident, or trauma and has experienced a
temporary lifestyle change requiring skilled nursing care;
(C) suffering from uncontrollable seizures or
other chronic illness; or
(D) chronically dependent on medical devices to
perform vital bodily functions.
(4) "Program" means the program to provide health care
services to medically fragile children established under Section
37.002.
(5) "Wrap-around benefits" means a service, including
a pharmacy or medical benefit:
(A) not covered under a private health benefit
plan or a public benefit program, including Medicaid and the child
health plan program, in which the child is enrolled; or
(B) covered under a private health benefit plan
in which the child is enrolled but the child has exceeded the
private health benefit plan coverage limit.
Sec. 37.002. ESTABLISHMENT OF PROGRAM. The commission,
exclusive of Medicaid, by rule shall develop and implement a
program under which health care services are provided to medically
fragile children with a rare and unique disease or medical
condition. The program must:
(1) provide benefits based on a child's diagnosis; and
(2) be designed to provide wrap-around benefits to
children participating in the program.
Sec. 37.003. ELIGIBLE CHILDREN. (a) The executive
commissioner by rule shall identify the diagnoses considered rare
and unique for purposes of determining eligibility under the
program.
(b) The executive commissioner may not impose income
eligibility requirements under the program.
Sec. 37.004. COVERED HEALTH CARE SERVICES. (a) Eligible
health care services under the program must include:
(1) specialized nutritional support, including
enteral nutrition;
(2) physical or occupational therapy;
(3) speech therapy;
(4) music therapy;
(5) aqua-therapy;
(6) hippotherapy;
(7) private duty nursing services in home or
educational environments;
(8) chiropractic services; and
(9) any other health care service or therapy the
commission determines necessary.
(b) To receive services under the program, the executive
commissioner may require that a participant provide evidence:
(1) from a health care provider that the proposed
services are medically necessary; and
(2) if the participant has private health benefit plan
coverage, that:
(A) the service is not covered under the plan;
(B) the issuer has denied coverage under the
plan; or
(C) the participant has met the applicable
coverage limit under the plan.
Sec. 37.005. MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM
ACCOUNT. (a) The medically fragile children assistance program
account is an account in the general revenue fund.
(b) The account consists of:
(1) appropriations of money to the account by the
legislature;
(2) gifts, grants, including federal grants, and other
donations received under Section 37.006; and
(3) interest earned on the investment of money in the
account.
(c) Money in the account may be appropriated only to the
commission for purposes of the program.
Sec. 37.006. GIFTS, GRANTS, AND DONATIONS. The commission
may accept gifts, grants, and donations from any source that are
made for the purposes of the program. The commission shall deposit
money received under this section to the credit of the medically
fragile children assistance program account.
SECTION 2. Not later than January 1, 2022, the Health and
Human Services Commission shall establish the program to provide
health care services to medically fragile children established
under Section 37.002, Human Resources Code, as added by this Act.
SECTION 3. This Act takes effect September 1, 2021.