Texas 2025 - 89th Regular

Texas House Bill HB3910 Compare Versions

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

Old	New	Differences
1	1	89R5703 LRM-F
2	2	By: Villalobos H.B. No. 3910
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to presumptive eligibility of certain individuals for
10	10	nursing facility care under Medicaid.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
13	13	is amended by adding Section 32.02605 to read as follows:
14	14	Sec. 32.02605. PRESUMPTIVE ELIGIBILITY OF CERTAIN
15	15	APPLICANTS NEEDING NURSING FACILITY CARE. (a) In this section:
16	16	(1) "Applicant" means an applicant for medical
17	17	assistance.
18	18	(2) "Nursing facility" means a convalescent or nursing
19	19	home or related institution licensed under Chapter 242, Health and
20	20	Safety Code, that provides long-term services and supports to
21	21	residents of the facility.
22	22	(b) The executive commissioner shall by rule develop and
23	23	implement a process providing for the determination and
24	24	certification of presumptive eligibility for medical assistance of
25	25	an applicant who needs nursing facility care.
26	26	(c) The process established under this section must:
27	27	(1) provide medical assistance benefits under a
28	28	presumptive eligibility determination for a period of not more than
29	29	90 days;
30	30	(2) provide a preliminary screening tool to nursing
31	31	facilities that will allow the facilities to make a reasonable
32	32	determination as to whether an applicant:
33	33	(A) meets the level of care criteria for medical
34	34	necessity for nursing facility care; and
35	35	(B) is likely to be eligible for medical
36	36	assistance; and
37	37	(3) require an applicant to sign a written agreement:
38	38	(A) attesting to the accuracy of financial and
39	39	other information the applicant provides and on which presumptive
40	40	eligibility is based; and
41	41	(B) acknowledging that:
42	42	(i) state-funded services are subject to
43	43	the period prescribed by Subdivision (1); and
44	44	(ii) the applicant is required to comply
45	45	with Subsection (d).
46	46	(d) An individual must complete and submit an application
47	47	for medical assistance before the individual may be determined
48	48	presumptively eligible for medical assistance under the process
49	49	established by the commission under this section.
50	50	(e) Not later than the 45th day after the date the
51	51	commission receives an application under Subsection (d), the
52	52	commission shall make a final determination of eligibility for
53	53	medical assistance.
54	54	(f) To the extent permitted by federal law, the commission
55	55	shall retroactively apply a final determination of eligibility for
56	56	medical assistance under Subsection (e) for a period that does not
57	57	exceed the 90-day period prescribed by Subsection (c)(1).
58	58	(g) To the extent permitted by federal law and subject to
59	59	Subsection (h), if the commission fails to make a final
60	60	determination of eligibility within the 45-day period required by
61	61	Subsection (e), the commission, at the request of a nursing
62	62	facility, shall provide medical assistance reimbursement to the
63	63	facility for health care services the facility provides to an
64	64	applicant during the period the applicant is determined
65	65	presumptively eligible for medical assistance under this section.
66	66	(h) If the commission makes a final determination that an
67	67	applicant for whom reimbursement is provided under Subsection (g)
68	68	is not eligible for medical assistance, the nursing facility must
69	69	pay back all money received by the facility as reimbursement under
70	70	that subsection. The commission may provide medical assistance
71	71	reimbursement to a nursing facility under Subsection (g) only if
72	72	the facility agrees in writing to comply with this subsection.
73	73	(i) The executive commissioner shall adopt rules necessary
74	74	to implement this section, including rules prescribing the form and
75	75	manner a nursing facility:
76	76	(1) may request medical assistance reimbursement
77	77	under Subsection (g); and
78	78	(2) if an applicant is determined ineligible for
79	79	medical assistance, pays back the money received by the facility
80	80	under Subsection (h).
81	81	SECTION 2. If before implementing any provision of this Act
82	82	a state agency determines that a waiver or authorization from a
83	83	federal agency is necessary for implementation of that provision,
84	84	the agency affected by the provision shall request the waiver or
85	85	authorization and may delay implementing that provision until the
86	86	waiver or authorization is granted.
87	87	SECTION 3. This Act takes effect September 1, 2025.