HB3910 - Relating to presumptive eligibility of certain individuals for nursing facility care under Medicaid.

  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.