Tex.
Gov't Code Section 531.06011
Certain Medicaid Waiver Programs: Interest List Management
(a)
This section applies only with respect to the following waiver programs:(1)
the community living assistance and support services (CLASS) waiver program;(2)
the home and community-based services (HCS) waiver program;(3)
the deaf-blind with multiple disabilities (DBMD) waiver program;(4)
the Texas home living (TxHmL) waiver program;(5)
the medically dependent children (MDCP) waiver program; and(6)
the STAR+PLUS home and community-based services (HCBS) program.(b)
The commission, in consultation with the Intellectual and Developmental Disability System Redesign Advisory Committee established under Section 534.053 (Intellectual and Developmental Disability System Redesign Advisory Committee), the state Medicaid managed care advisory committee, and interested stakeholders, shall develop a questionnaire to be completed by or on behalf of an individual who requests to be placed on or is currently on an interest list for a waiver program.(c)
The questionnaire developed under Subsection (b) must, at a minimum, request the following information about an individual seeking or receiving services under a waiver program:(1)
contact information for the individual or the individual’s parent or other legally authorized representative;(2)
the individual’s general demographic information;(3)
the individual’s living arrangement;(4)
the types of assistance the individual requires;(5)
the individual’s current caregiver supports and circumstances that may cause the individual to lose those supports; and(6)
when the delivery of services under a waiver program should begin to ensure the individual’s health and welfare and that the individual receives services and supports in the least restrictive setting possible.(d)
If an individual is on a waiver program’s interest list and the individual or the individual’s parent or other legally authorized representative does not respond to a written or verbal request made by the commission to update information concerning the individual or otherwise fails to maintain contact with the commission, the commission:(1)
shall designate the individual’s status on the interest list as inactive until the individual or the individual’s parent or other legally authorized representative notifies the commission that the individual is still interested in receiving services under the waiver program; and(2)
at the time the individual or the individual’s parent or other legally authorized representative provides notice to the commission under Subdivision (1), shall designate the individual’s status on the interest list as active and restore the individual to the position on the list that corresponds with the date the individual was initially placed on the list.(e)
The commission’s designation of an individual’s status on an interest list as inactive under Subsection (d) may not result in the removal of the individual from that list or any other waiver program interest list.(f)
Not later than September 1 of each year, the commission shall provide to the Intellectual and Developmental Disability System Redesign Advisory Committee established under Section 534.053 (Intellectual and Developmental Disability System Redesign Advisory Committee), or, if that advisory committee is abolished, an appropriate stakeholder advisory committee, as determined by the executive commissioner, the number of individuals, including individuals whose status is designated as inactive by the commission, who are on an interest list to receive services under a waiver program.(b)
The commission shall require the parent’s or representative’s signature to verify the parent or representative received the results of the initial assessment or reassessment from the care coordinator under Subsection (a). A Medicaid managed care organization may not delay the delivery of care pending the signature.(c)
The commission shall provide a parent or representative who disagrees with the results of the initial assessment or reassessment an opportunity to request to dispute the results with the Medicaid managed care organization through a peer-to-peer review with the treating physician of choice.(d)
This section does not affect any rights of a recipient to appeal an initial assessment or reassessment determination through the Medicaid managed care organization’s internal appeal process, the Medicaid fair hearing process, or the external medical review process.(a)
The commission, based on the state’s external quality review organization’s initial report on the STAR Kids managed care program, shall determine whether the findings of the report necessitate additional data and research to improve the program. If the commission determines additional data and research are needed, the commission, through the external quality review organization, may:(1)
conduct annual surveys of Medicaid recipients receiving benefits under the medically dependent children (MDCP) waiver program, or their representatives, using the Consumer Assessment of Healthcare Providers and Systems;(2)
conduct annual focus groups with recipients described by Subdivision (1) or their representatives on issues identified through:(A)
the Consumer Assessment of Healthcare Providers and Systems;(B)
other external quality review organization activities; or(C)
stakeholders, including the STAR Kids Managed Care Advisory Committee described by Section 533.00254 (Star Kids Managed Care Advisory Committee); and(3)
in consultation with the STAR Kids Managed Care Advisory Committee described by Section 533.00254 (Star Kids Managed Care Advisory Committee) and as frequently as feasible, calculate Medicaid managed care organizations’ performance on performance measures using available data sources such as the collaborative innovation improvement network.(b)
The commission shall submit to the governor, the lieutenant governor, the speaker of the house of representatives, the Legislative Budget Board, and each standing legislative committee with primary jurisdiction over Medicaid a semiannual report containing, for the preceding six-month period, the following information and data related to access to care for Medicaid recipients receiving benefits under the medically dependent children (MDCP) waiver program:(1)
enrollment in the Medicaid buy-in for children program implemented under Section 531.02444 (Medicaid Buy-in Programs for Certain Persons with Disabilities);(2)
requests relating to interest list placements under Section 531.0601 (Long-term Care Services Waiver Program Interest Lists);(3)
use of the Medicaid escalation help line established under Section 533.00253 (Star Kids Medicaid Managed Care Program), if the help line was operational during the applicable six-month period;(4)
use of, requests for, and outcomes of the external medical review procedure established under Section 531.024164 (External Medical Review); and(5)
complaints relating to the medically dependent children (MDCP) waiver program, categorized by disposition.(1)
is diagnosed as having a condition included in the list of compassionate allowances conditions published by the United States Social Security Administration; or(2)
receives Medicaid hospice or palliative care services.(b)
If the commission determines a child is eligible for a waiver program under Subsection (a), the child’s enrollment in the applicable program is contingent on the availability of a slot in the program. If a slot is not immediately available, the commission shall place the child in the first position on the interest list for the medically dependent children (MDCP) waiver program or deaf-blind with multiple disabilities (DBMD) waiver program, as applicable.
Source:
Section 531.06011 — Certain Medicaid Waiver Programs: Interest List Management, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.531.htm#531.06011 (accessed Jun. 5, 2024).
