Tex.
Human Resources Code Section 32.052
Waiver Programs for Children with Disabilities or Special Health Care Needs
(a)
This section applies to services under the medical assistance program provided to children younger than 23 years of age with disabilities or special health care needs under a waiver granted under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)).(b)
In this section, “permanency planning” means a philosophy and planning process designed to achieve family support through the facilitation of a permanent living arrangement that has as its primary feature an enduring and nurturing parental relationship.(c)
In developing and providing services subject to this section, the commission shall:(1)
fully assess a child at the time the child applies for assistance to determine all appropriate services for the child under the medical assistance program, including both waiver and nonwaiver services;(2)
ensure that permanency planning is implemented to identify and establish the family support necessary to maintain a child’s permanent living arrangement with a family;(3)
implement a transition and referral process to prevent breaks in services when a child is leaving a medical assistance waiver program or moving between service delivery systems due to a change in the child’s disability status or needs, aging out of the current delivery system, or moving between geographic areas within the state;(4)
identify and provide core services addressing a child’s developmental needs and the needs of the child’s family to strengthen and maintain the child’s family;(5)
provide for comprehensive coordination and use of available services and resources in a manner that ensures support for families in keeping their children at home;(6)
ensure that eligibility requirements, assessments for service needs, and other components of service delivery are designed to be fair and equitable for all families, including families with parents who work outside the home; and(7)
provide for a broad array of service options and a reasonable choice of service providers.(d)
To ensure that services subject to this section are cost neutral and not duplicative of other services provided under the medical assistance program, the commission shall coordinate the provision of services subject to this section with services provided under the Texas Health Steps Comprehensive Care Program.(e)
Repealed by Acts 2015, 84th Leg., R.S., Ch. 1, Sec. 4.465(a)(41), eff. April 2, 2015.(f)
Repealed by Acts 2015, 84th Leg., R.S., Ch. 1, Sec. 4.465(a)(41), eff. April 2, 2015.(b)
The executive commissioner shall adopt rules as necessary to implement this section. In adopting rules, the executive commissioner shall:(1)
use the Bienvivir Senior Health Services of El Paso initiative as a model for the program;(2)
ensure that a person is not required to hold a certificate of authority as a health maintenance organization under Chapter 843 (Health Maintenance Organizations), Insurance Code, to provide services under the PACE program;(3)
ensure that participation in the PACE program is available as an alternative to enrollment in a Medicaid managed care plan under Chapter 533, Government Code, for eligible recipients, including recipients eligible for assistance under both the medical assistance and Medicare programs;(4)
ensure that managed care organizations that contract under Chapter 533, Government Code, consider the availability of the PACE program when considering whether to refer a recipient to a nursing facility or other long-term care facility; and(5)
establish protocols for the referral of eligible persons to the PACE program.(b)
The executive commissioner shall adopt rules as necessary to implement this section. In adopting rules, the executive commissioner shall:(1)
use the Bienvivir Senior Health Services of El Paso initiative as a model for the program;(2)
ensure that a person is not required to hold a certificate of authority as a health maintenance organization under Chapter 843 (Health Maintenance Organizations), Insurance Code, to provide services under the PACE program;(3)
ensure that participation in the PACE program is available as an alternative to enrollment in a Medicaid managed care plan under Chapter 540 (Medicaid Managed Care Program), Government Code, for eligible recipients, including recipients eligible for assistance under both the medical assistance and Medicare programs;(4)
ensure that managed care organizations that contract under Chapter 540 (Medicaid Managed Care Program), Government Code, consider the availability of the PACE program when considering whether to refer a recipient to a nursing facility or other long-term care facility; and(5)
establish protocols for the referral of eligible persons to the PACE program.(c)
The commission may not contract with a person to provide services under the PACE program unless the person:(1)
purchases reinsurance in an amount determined by the commission that is sufficient to ensure the person’s continued solvency; or(2)
has the financial resources sufficient to cover expenses in the event of the person’s insolvency.(d)
To demonstrate sufficiency of financial resources for purposes of Subsection (c)(2), a person may use cash reserves, a letter of credit, a guarantee of a company affiliated with the person, or a combination of those arrangements. The amount of a person’s financial arrangement must be at least equal to the sum of:(1)
the total capitation revenue for one month; and(2)
the average monthly payment of operating expenses.(e)
The Department of Aging and Disability Services and area agencies on aging shall develop and implement a coordinated plan to promote PACE program sites operating under this section. The executive commissioner shall adopt policies and procedures, including operating guidelines, to ensure that caseworkers and any other appropriate department staff discuss the benefits of participating in the PACE program with long-term care clients.(f)
The commission shall consider the PACE program as a community-based service option under any “Money Follows the Person” demonstration project or other initiative that is designed to eliminate barriers or mechanisms that prevent or restrict the flexible use of funds under the medical assistance program to enable a recipient to receive long-term services or supports in a setting of the recipient’s choice.(g)
A PACE program site may coordinate with entities that are eligible to obtain discount prescription drug prices under Section 340B, Public Health Service Act (42 U.S.C. Section 256b), as necessary to enable the PACE program site to obtain those discounts.(h)
The executive commissioner shall adopt a standard reimbursement methodology for the payment of all PACE organizations for purposes of encouraging a natural increase in the number of PACE program sites throughout the state.(i)
To the extent allowed by the General Appropriations Act, the commission may transfer general revenue funds appropriated to the commission for the medical assistance program to the Department of Aging and Disability Services to provide PACE services in PACE program service areas to eligible recipients whose medical assistance benefits would otherwise be delivered as home and community-based services through the STAR + PLUS Medicaid managed care program and whose personal incomes are at or below the level of income required to receive Supplemental Security Income (SSI) benefits under 42 U.S.C. Section 1381 et seq.
Source:
Section 32.052 — Waiver Programs for Children with Disabilities or Special Health Care Needs, https://statutes.capitol.texas.gov/Docs/HR/htm/HR.32.htm#32.052 (accessed Jun. 5, 2024).
