88R14024 JG-F
By: Thierry H.B. No. 3551
A BILL TO BE ENTITLED
AN ACT
relating to presumptive eligibility of certain elderly individuals
for home and community-based services under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.02605 to read as follows:
Sec. 32.02605. PRESUMPTIVE ELIGIBILITY OF CERTAIN ELDERLY
INDIVIDUALS FOR HOME AND COMMUNITY-BASED SERVICES. (a) In this
section, "elderly individual" means an individual who is 65 years
of age or older.
(b) The executive commissioner by rule shall adopt a program
providing for:
(1) the determination and certification of
presumptive eligibility for medical assistance of an elderly
individual who requires a skilled level of nursing care; and
(2) the provision through the medical assistance
program to the individual of that care in a home or community-based
setting instead of in an institutional setting, provided the
individual applies for and meets the basic eligibility requirements
for medical assistance.
(c) The program established under this section must:
(1) provide medical assistance benefits under a
presumptive eligibility determination for a period of not more than
90 days;
(2) establish eligibility criteria and a process for
determining the entities authorized to make determinations of
presumptive eligibility under the program;
(3) provide a preliminary screening tool to entities
described by Subdivision (2) that will allow representatives of
those entities to:
(A) make a determination as to whether an
applicant is:
(i) functionally able to live at home or in
a community setting; and
(ii) likely to be financially eligible for
medical assistance;
(B) make the determination under Paragraph
(A)(ii) not later than the fourth day after the date a determination
is made under Paragraph (A)(i); and
(C) initiate the provision of medical assistance
benefits not later than the fifth day after the date an applicant is
determined eligible under Paragraph (A)(i); and
(4) require an applicant to sign a written agreement:
(A) attesting to the accuracy of financial and
other information the applicant provides and on which presumptive
eligibility is based; and
(B) acknowledging that:
(i) state-funded services are subject to
the period prescribed by Subdivision (1); and
(ii) the applicant is required to comply
with Subsection (d).
(d) An applicant who is determined presumptively eligible
for medical assistance under the program established by this
section must complete an application for medical assistance not
later than the 10th day after the date the applicant is screened for
functional eligibility under Subsection (c)(3)(A)(i).
(e) Not later than the 45th day after the date the
commission receives an application under Subsection (d), the
commission shall make a final determination of eligibility for
medical assistance.
(f) To the extent permitted by federal law, the commission
shall retroactively apply a final determination of eligibility for
medical assistance under Subsection (e) for a period that does not
precede the 90th day before the date the application was filed under
Subsection (d).
(g) The commission shall submit to the standing committees
of the senate and house of representatives having jurisdiction over
the medical assistance program an annual report that details:
(1) the number of individuals determined
presumptively eligible for medical assistance under the program
established under this section;
(2) the savings to the state based on how much
institutional care would have cost for individuals determined
presumptively eligible for medical assistance under the program
established under this section who were later determined eligible
for medical assistance; and
(3) the number of individuals determined
presumptively eligible for medical assistance under the program
established under this section who were later determined not
eligible for medical assistance and the cost to the state to provide
those individuals with home or community-based services before the
final determination of eligibility for medical assistance.
(h) The report required under Subsection (g) may be combined
with any other report required by this chapter or other law.
SECTION 2. 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 3. This Act takes effect September 1, 2023.