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.