HB3981 - Relating to the establishment of the case assistance affiliate program to provide certain assistance to Medicaid recipients and child health plan program enrollees.

  89R11174 AND-F     By: Rose H.B. No. 3981       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.