87R12431 KKR-D     By: Bucy H.B. No. 4311       A BILL TO BE ENTITLED   AN ACT   relating to establishing an assistance program to provide certain   health care services to certain medically fragile children.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle C, Title 2, Human Resources Code, is   amended by adding Chapter 37 to read as follows:   CHAPTER 37. MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM          Sec. 37.001.  DEFINITIONS. In this chapter:                (1)  "Child health plan program" means the child health   plan program established under Chapters 62 and 63, Health and   Safety Code.                (2)  "Medicaid" means the medical assistance program   established under Chapter 32.                (3)  "Medically fragile child" means a person younger   than 21 years of age who is:                      (A)  chronically ill or disabled and requires   indefinite skilled nursing care to maintain the person's existence   in the person's home;                      (B)  temporarily ill or disabled because of   premature birth, accident, or trauma and has experienced a   temporary lifestyle change requiring skilled nursing care;                      (C)  suffering from uncontrollable seizures or   other chronic illness; or                      (D)  chronically dependent on medical devices to   perform vital bodily functions.                (4)  "Program" means the program to provide health care   services to medically fragile children established under Section   37.002.                (5)  "Wrap-around benefits" means a service, including   a pharmacy or medical benefit:                      (A)  not covered under a private health benefit   plan or a public benefit program, including Medicaid and the child   health plan program, in which the child is enrolled; or                      (B)  covered under a private health benefit plan   in which the child is enrolled but the child has exceeded the   private health benefit plan coverage limit.          Sec. 37.002.  ESTABLISHMENT OF PROGRAM. The commission,   exclusive of Medicaid, by rule shall develop and implement a   program under which health care services are provided to medically   fragile children with a rare and unique disease or medical   condition. The program must:                (1)  provide benefits based on a child's diagnosis; and                (2)  be designed to provide wrap-around benefits to   children participating in the program.          Sec. 37.003.  ELIGIBLE CHILDREN. (a)  The executive   commissioner by rule shall identify the diagnoses considered rare   and unique for purposes of determining eligibility under the   program.          (b)  The executive commissioner may not impose income   eligibility requirements under the program.          Sec. 37.004.  COVERED HEALTH CARE SERVICES. (a)  Eligible   health care services under the program must include:                (1)  specialized nutritional support, including   enteral nutrition;                (2)  physical or occupational therapy;                (3)  speech therapy;                (4)  music therapy;                (5)  aqua-therapy;                (6)  hippotherapy;                (7)  private duty nursing services in home or   educational environments;                (8)  chiropractic services; and                (9)  any other health care service or therapy the   commission determines necessary.          (b)  To receive services under the program, the executive   commissioner may require that a participant provide evidence:                (1)  from a health care provider that the proposed   services are medically necessary; and                (2)  if the participant has private health benefit plan   coverage, that:                      (A)  the service is not covered under the plan;                      (B)  the issuer has denied coverage under the   plan; or                      (C)  the participant has met the applicable   coverage limit under the plan.          Sec. 37.005.  MEDICALLY FRAGILE CHILDREN ASSISTANCE PROGRAM   ACCOUNT. (a)  The medically fragile children assistance program   account is an account in the general revenue fund.          (b)  The account consists of:                (1)  appropriations of money to the account by the   legislature;                (2)  gifts, grants, including federal grants, and other   donations received under Section 37.006; and                (3)  interest earned on the investment of money in the   account.          (c)  Money in the account may be appropriated only to the   commission for purposes of the program.          Sec. 37.006.  GIFTS, GRANTS, AND DONATIONS.  The commission   may accept gifts, grants, and donations from any source that are   made for the purposes of the program. The commission shall deposit   money received under this section to the credit of the medically   fragile children assistance program account.          SECTION 2.  Not later than January 1, 2022, the Health and   Human Services Commission shall establish the program to provide   health care services to medically fragile children established   under Section 37.002, Human Resources Code, as added by this Act.          SECTION 3.  This Act takes effect September 1, 2021.