2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.1065. Recipient Enrollment, Participation, and Eligibility

Text of section effective until April 01, 2025
Sec. 534.1065.  RECIPIENT ENROLLMENT, PARTICIPATION, AND ELIGIBILITY.  (a)  An individual who is eligible for the pilot program will be enrolled automatically, and the decision whether to opt out of participation in the pilot program and not receive long-term services and supports under the pilot program may be made only by the individual or the individual's legally authorized representative.
(b)  To ensure prospective pilot program participants are able to make an informed decision on whether to participate in the pilot program, the commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall develop and distribute informational materials on the pilot program that describe the pilot program's benefits, the pilot program's impact on current services, and other related information.  The commission shall establish a timeline and process for the development and distribution of the materials and shall ensure:
(1)  the materials are developed and distributed to individuals eligible to participate in the pilot program with sufficient time to educate the individuals, their families, and other persons actively involved in their lives regarding the pilot program;
(2)  individuals eligible to participate in the pilot program, including individuals enrolled in the STAR+PLUS Medicaid managed care program, their families, and other persons actively involved in their lives, receive the materials and oral information on the pilot program;
(3)  the materials contain clear, simple language presented in a manner that is easy to understand; and
(4)  the materials explain, at a minimum, that:
(A)  on conclusion of the pilot program, pilot program participants will be asked to provide feedback on their experience, including feedback on whether the pilot program was able to meet their unique support needs;
(B)  participation in the pilot program does not remove individuals from any Medicaid waiver program interest list;
(C)  individuals who choose to participate in the pilot program and who, during the pilot program's operation, are offered enrollment in a Medicaid waiver program may accept the enrollment, transition, or diversion offer; and
(D)  pilot program participants have a choice among acute care and comprehensive long-term services and supports providers and service delivery options, including the consumer direction model and comprehensive services model.
(c)  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall develop pilot program participant eligibility criteria.  The criteria must ensure pilot program participants:
(1)  include individuals with an intellectual or developmental disability or a cognitive disability, including:
(A)  individuals with autism;
(B)  individuals with significant complex behavioral, medical, and physical needs who are receiving home and community-based services through the STAR+PLUS Medicaid managed care program;
(C)  individuals enrolled in the STAR+PLUS Medicaid managed care program who:
(i)  are on a Medicaid waiver program interest list;
(ii)  meet the criteria for an intellectual or developmental disability; or
(iii)  have a traumatic brain injury that occurred after the age of 21; and
(D)  other individuals with disabilities who have similar functional needs without regard to the age of onset or diagnosis; and
(2)  do not include individuals who are receiving only acute care services under the STAR+PLUS Medicaid managed care program and are enrolled in the community-based ICF-IID program or another Medicaid waiver program.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 18, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.