Medicaid plans help members with benefits paperwork

The text as introduced · 738 words

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.