89R11174 AND-F
By: Blanco S.B. No. 999
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of the case assistance affiliate
program to provide certain assistance to Medicaid recipients and
child health plan program enrollees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 545, Government Code, as effective April
1, 2025, is amended by adding Subchapter F to read as follows:
SUBCHAPTER F. CASE ASSISTANCE AFFILIATE PROGRAM
Sec. 545.0251. DEFINITIONS. In this subchapter:
(1) "Benefit case management services" means
assisting a client or member of the client's household to apply for
and manage other benefits for which the client may be eligible.
(2) "Case assistance" means providing a client:
(A) application and renewal assistance under
Medicaid or the child health plan program, as appropriate; and
(B) benefit case management services under
public benefits programs, including the financial and nutritional
assistance programs.
(3) "Case assistance affiliate" means a managed care
organization or dental maintenance organization that provides case
assistance to clients and members of the clients' households.
(4) "Case assistant" means an employee of a case
assistance affiliate who directly provides case assistance to a
client or a member of the client's household.
(5) "Client" means, with respect to a managed care
organization or dental maintenance organization, a recipient or
enrollee who is enrolled in the organization's managed care plan.
(6) "Enrollee" means an individual enrolled in the
child health plan program.
(7) "Program" means the case assistance affiliate
program established under this subchapter.
(8) "Program manager" means the employee of a case
assistance affiliate who is designated by the affiliate to oversee:
(A) case assistants; and
(B) the provision of case assistance services
under the program.
(9) "Recipient" means a Medicaid recipient.
Sec. 545.0252. ESTABLISHMENT OF CASE ASSISTANCE AFFILIATE
PROGRAM. (a) The commission shall:
(1) establish a statewide case assistance affiliate
program under which managed care organizations and dental
maintenance organizations that participate in Medicaid or the child
health plan program are authorized to operate as case assistance
affiliates by providing, to the extent permitted by federal law,
case assistance to their clients and members of their clients'
households; and
(2) provide a training and certification process for
program managers and case assistants providing services under the
program.
(b) In establishing the program, the commission:
(1) shall consult with:
(A) experts, as determined by the commission; and
(B) other interested persons, including managed
care organizations and dental maintenance organizations
participating in Medicaid or the child health plan program; and
(2) may establish a work group or advisory committee
that includes interested persons to advise the commission on the
establishment of the program.
Sec. 545.0253. AUTHORIZED SERVICES. Under the program, a
case assistance affiliate may:
(1) provide case assistance by any appropriate means,
including in person or virtually using a computer, tablet, or other
electronic device; and
(2) with the consent of the client, submit to the
commission an application for benefits on behalf of the client
using the client's captured electronic signature.
Sec. 545.0254. PROHIBITED SERVICES. Under the program, a
case assistance affiliate may not:
(1) provide counseling to a client on choosing a
managed care plan in which to enroll; or
(2) assist a client in completing fields on benefit
forms associated with managed care plan selection.
Sec. 545.0255. RULES: PROGRAM REQUIREMENTS AND STANDARDS.
The executive commissioner shall adopt rules necessary to implement
the program, including rules:
(1) establishing requirements for a managed care
organization or dental maintenance organization to participate in
the program;
(2) establishing the training and certification
process required by Section 545.0252(a)(2);
(3) providing for the suspension, revocation, and, as
appropriate, periodic renewal of a case assistant's or program
manager's certification;
(4) protecting the confidentiality of clients'
information; and
(5) establishing any other standards or requirements
the executive commissioner determines necessary.
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 immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2025.