Bill Text: TX HB2368 | 2011-2012 | 82nd Legislature | Comm Sub


Bill Title: Relating to copayments and other cost-sharing payments under the medical assistance program.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2011-04-27 - Committee report sent to Calendars [HB2368 Detail]

Download: Texas-2011-HB2368-Comm_Sub.html
  82R22116 KFF-F
 
  By: Parker H.B. No. 2368
 
  Substitute the following for H.B. No. 2368:
 
  By:  Truitt C.S.H.B. No. 2368
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to copayments and other cost-sharing payments under the
  medical assistance program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Sections 32.064(a) and (b), Human Resources
  Code, are amended to read as follows:
         (a)  To the extent permitted under Title XIX, Social Security
  Act (42 U.S.C. Section 1396 et seq.), as amended, and any other
  applicable law or regulations, the executive commissioner of the 
  Health and Human Services Commission shall adopt provisions
  requiring recipients of medical assistance to share the cost of
  medical assistance, including provisions requiring recipients to
  pay:
               (1)  an enrollment fee;
               (2)  a deductible; [or]
               (3)  coinsurance or a portion of the plan premium, if
  the recipients receive medical assistance under the Medicaid
  managed care program under Chapter 533, Government Code, or a
  Medicaid managed care demonstration project under Section 32.041;
  or
               (4)  a copayment in accordance with Section 32.0641(c).
         (b)  Subject to Subsection (d) and except as provided by
  Section 32.0641(c), cost-sharing provisions adopted under this
  section shall ensure that families with higher levels of income are
  required to pay progressively higher percentages of the cost of the
  medical assistance.
         SECTION 2.  The heading to Section 32.0641, Human Resources
  Code, is amended to read as follows:
         Sec. 32.0641.  COST SHARING FOR CERTAIN HEALTH CARE 
  [HIGH-COST MEDICAL] SERVICES.
         SECTION 3.  Section 32.0641, Human Resources Code, is
  amended by amending Subsections (a) and (c) and adding Subsections
  (a-1) and (d) to read as follows:
         (a)  To [If the department determines that it is feasible and
  cost-effective, and to] the extent permitted under Title XIX,
  Social Security Act (42 U.S.C. Section 1396 et seq.) and any other
  applicable law or regulation or under a federal waiver or other
  authorization, and subject to Subsection (c), the executive
  commissioner of the Health and Human Services Commission shall
  adopt cost-sharing provisions that encourage personal
  accountability and appropriate utilization of health care
  services.
         (a-1)  The executive commissioner of the Health and Human
  Services Commission shall adopt a cost-sharing provision under
  Subsection (a) that requires [require] a recipient who chooses to
  receive a nonemergency [a high-cost] medical service [provided]
  through a hospital emergency room to pay a copayment[, premium
  payment,] or other cost-sharing payment for the nonemergency 
  [high-cost] medical service if:
               (1)  the hospital from which the recipient seeks
  service:
                     (A)  performs an appropriate medical screening
  and determines that the recipient does not have a condition
  requiring emergency medical services;
                     (B)  informs the recipient:
                           (i)  that the recipient does not have a
  condition requiring emergency medical services;
                           (ii)  that, if the hospital provides the
  nonemergency medical service, the hospital may require payment of a
  copayment[, premium payment,] or other cost-sharing payment by the
  recipient in advance; and
                           (iii)  of the name and address of a
  nonemergency Medicaid provider who can provide the appropriate
  medical service without imposing a cost-sharing payment; and
                     (C)  offers to provide the recipient with a
  referral to the nonemergency provider to facilitate scheduling of
  the service; and
               (2)  after receiving the information and assistance
  described by Subdivision (1) from the hospital, the recipient
  chooses to obtain [emergency] medical services through the hospital
  emergency room despite having access to appropriate and medically
  acceptable[, lower-cost] medical services.
         (c)  If the executive commissioner of the Health and Human
  Services Commission adopts copayments [a copayment or other
  cost-sharing payment] under Subsection (a) for the following health
  care services, the executive commissioner shall require that a
  recipient pay copayments in the following amounts:
               (1)  not more than $5 for each hospital outpatient
  visit at the time of the visit, other than a visit for a
  nonemergency medical service provided through a hospital emergency
  room;
               (2)  not more than $5 for each medical visit with a
  physician at the time of the visit; and
               (3)  not more than $7.50 per prescription drug 
  [commission may not reduce hospital payments to reflect the
  potential receipt of a copayment or other payment from a recipient
  receiving medical services provided through a hospital emergency
  room].
         (d)  Subsection (c) does not require a medical assistance
  provider to bill or collect from a recipient a copayment required or
  authorized under this section.
         SECTION 4.  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 5.  This Act takes effect September 1, 2011.
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