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Relating to the operation and administration of Medicaid, including the Medicaid managed care program and the medically dependent children (MDCP) waiver program.
Estimated Two-year Net Impact to General Revenue Related Funds for SB1207, Committee Report 2nd House, Substituted: a negative impact of ($9,013,801) through the biennium ending August 31, 2021.
The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. The agency is required to implement a provision of this Act only if the legislature appropriates money specifically for that purpose. If the legislature does not appropriate money specifically for that purpose, the agency may, but is not required to, implement a provision of this Act using other appropriations available for that purpose. Additional costs related the cost impact of changes to managed care organization capitation rates.
SB 1207 would require the executive commissioner of the Health and Human Services Commission (HHSC) to increase the maximum family income for determining eligibility for the Medicaid buy-in program for children with disabilities to the maximum family income amount for which federal matching funds are available, considering available appropriations for that purpose. HHSC would be required to conduct a disability determination assessment of the child (at the parent's request) to determine the child's eligibility for the program.
This bill would also require HHSC to ensure that notice sent to a Medicaid recipient or provider regarding the denial of coverage or prior authorization for a service includes certain information.
In regard to an external medical review, HHSC would be required to contract with an independent external medical reviewer to conduct the reviews, establish a common procedure, and establish a procedure for expedited reviews. Medicaid MCOs would be prohibited from having a financial relationship with or ownership interest in the external medical reviewer with which HHSC contracts.
In regard to children enrolled in the medically-dependent children waiver program (MDCP), but become ineligible because they no longer meet the level of care criteria for medical necessity for nursing facility care or the age requirement for the program, this bill would authorize such a child's legally authorized representative to request that HHSC: (1) return the child to the interest list for the program unless the child is ineligible due to age; or (2) place the child on the interest list for another specified waiver program.
This bill makes several other changes to the above-mentioned programs regarding their operation and administration.
Texas Action opposes CSSB 1207 because it violates the principle of limited government. The House committee substitute represents an expensive expansion of a public health benefit program. For these reasons we oppose CSSB 1207.