40 TAC 15.610
The Texas Department of Human Services (DHS) proposes to
amend §15.610, concerning Medicaid coverage, in its Medicaid Eligibility
chapter. The purpose of the amendment is that for certified SSI clients, Medicaid
coverage begins the month prior to the first month of SSI payment and is available
for the two preceding months if the client meets all criteria for that period.
Eric M. Bost, commissioner, has determined that for the first five-year
period the proposed amendment will be in effect there will be fiscal implications
for state or local governments as a result of enforcing or administering the
amendment. The effect on state government for the first five-year period the
amendment will be in effect is an estimated additional cost of $9,337,470
for fiscal year 1998; $9,974,763 for fiscal year 1999; $10,491,145 for fiscal
year 2000; $11,044,206 for fiscal year 2001; and $11,627,309 for fiscal year
2002, 100% state funds to be paid by the Texas Department of Health. There
will be no fiscal implications for local government.
Mr. Bost also has determined that for each year of the first five years
the amendment is in effect the public benefit anticipated as a result of enforcing
the amendment will be that there will be no gap in Medicaid coverage for certified
SSI clients who are also eligible for retroactive coverage. There will be
no effect on small businesses as a result of enforcing or administering the
amendment. There is no anticipated economic cost to persons who are required
to comply with the proposed amendment.
Questions about the content of this proposal may be directed to Judy Coker
at (512) 438-3227 in DHS's Long-Term Care section. Written comments on the
proposal may be submitted to Supervisor, Rules and Handbooks Unit-026, Texas
Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register.
The amendment is proposed under the Human Resources Code, Title
2, Chapters 22 and 32, which authorizes the department to administer public
and medical assistance programs and under Texas Government Code §531.021,
which provides the Health and Human Services Commission with the authority
to administer federal medical assis- tance funds.
The amendment implements §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
§15.610. Medicaid Coverage.
(a)-(b)
(No change.)
(c)
Retroactive
[
Three-months prior
]
coverage.
For certified SSI clients, Medicaid coverage automatically
begins with the month prior to the first month of SSI payment and is also
available for the two preceding months if the individual meets all Medicaid
eligibility requirements for those two months. For other clients, the
[
The
] three months considered in determining eligibility are those
months immediately before the month in which the individual
filed a denied
application for SSI,
filed a formal application for [
SSI or
]
MAO, transferred from a limited Medicaid program such as QMB, or the three
months before the month an application is received from a decedent's agent.
The department considers as potentially eligible for retroactive Medicaid
coverage the following individuals:
(1)-(3)
(No change.)
(d)
SSI-MAO eligibility requirements.
(1)
General requirements. Although the applicant need not
be currently eligible, he must prove that SSI-MAO requirements were met in
the month of requested coverage. Except for 1929(b) clients, a client eligible
for
retroactive
[
three months prior
] coverage receives
a medical care identification for the
appropriate
[
retroac-
tive
] period. He presents this information to providers so that claims
can be filed within 90 days of the Medicaid decision. To meet requirements,
the individual must have been
(A)-(E)
(No change.)
(2)
Prior coverage for SSI applicants. The SSI client
may apply for retroactive Medicaid coverage. To apply for retroactive medical
coverage, the client must complete both the application form, which is based
on current circumstances, and the application form attachment, which is based
on circumstances during the three months before application for SSI. An SSI
client who claims unpaid or reimbursable medical expenses incurred within
the retroactive period
[
three months before the date of application
] receives a computer-generated notice of potential eligibility. He
must contact the local department office for his eligibility to be determined.
The department determines his eligibility accord- ing to SSI program criteria.
An individual may be eligible for more than one
retroactive
[
three-month prior
] period if he applies for SSI more than once. Determination
of eligibility on a month-to-month basis may result in nonsequential periods
of eligibility. The department notifies the client about the eligibility determination
decision and sends him a medical identification card for his period of retroactive
eligibility.
(3)-(4)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
February 6, 1998.
TRD-9801692
Glenn Scott
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: March 22, 1998
For further information, please call: (512) 438-3765