bill presuming Medicaid eligibility for nursing home care

The text as introduced · 635 words

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.