89R5703 LRM-F
By: Villalobos H.B. No. 3910
A BILL TO BE ENTITLED
AN ACT
relating to presumptive eligibility of certain individuals for
nursing facility care 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
APPLICANTS NEEDING NURSING FACILITY CARE. (a) In this section:
(1) "Applicant" means an applicant for medical
assistance.
(2) "Nursing facility" means a convalescent or nursing
home or related institution licensed under Chapter 242, Health and
Safety Code, that provides long-term services and supports to
residents of the facility.
(b) The executive commissioner shall by rule develop and
implement a process providing for the determination and
certification of presumptive eligibility for medical assistance of
an applicant who needs nursing facility care.
(c) The process 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) provide a preliminary screening tool to nursing
facilities that will allow the facilities to make a reasonable
determination as to whether an applicant:
(A) meets the level of care criteria for medical
necessity for nursing facility care; and
(B) is likely to be eligible for medical
assistance; and
(3) 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 individual must complete and submit an application
for medical assistance before the individual may be determined
presumptively eligible for medical assistance under the process
established by the commission under this section.
(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
exceed the 90-day period prescribed by Subsection (c)(1).
(g) To the extent permitted by federal law and subject to
Subsection (h), if the commission fails to make a final
determination of eligibility within the 45-day period required by
Subsection (e), the commission, at the request of a nursing
facility, shall provide medical assistance reimbursement to the
facility for health care services the facility provides to an
applicant during the period the applicant is determined
presumptively eligible for medical assistance under this section.
(h) If the commission makes a final determination that an
applicant for whom reimbursement is provided under Subsection (g)
is not eligible for medical assistance, the nursing facility must
pay back all money received by the facility as reimbursement under
that subsection. The commission may provide medical assistance
reimbursement to a nursing facility under Subsection (g) only if
the facility agrees in writing to comply with this subsection.
(i) The executive commissioner shall adopt rules necessary
to implement this section, including rules prescribing the form and
manner a nursing facility:
(1) may request medical assistance reimbursement
under Subsection (g); and
(2) if an applicant is determined ineligible for
medical assistance, pays back the money received by the facility
under Subsection (h).
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, 2025.