Bill Text: TX HB12 | 2019-2020 | 86th Legislature | Engrossed


Bill Title: Relating to early childhood intervention and rehabilitative and habilitative services.

Spectrum: Bipartisan Bill

Status: (Engrossed) 2019-05-07 - Received from the House [HB12 Detail]

Download: Texas-2019-HB12-Engrossed.html
 
 
  By: Davis of Harris, Harless, Price, Zerwas, H.B. No. 12
      Guerra, et al.
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
 
  relating to early childhood intervention and rehabilitative and
  habilitative services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 73.009(a), Human Resources Code, is
  amended to read as follows:
         (a)  The commission [department] shall develop and the
  executive commissioner shall establish policies concerning
  services described by this section. A child under three years of
  age and the child's parent, guardian, or other legally authorized
  representative [family] may be referred for services described by
  this section if the child is:
               (1)  identified as having a developmental delay;
               (2)  suspected of having a developmental delay; or
               (3)  considered at risk of developmental delay.
         SECTION 2.  Chapter 73, Human Resources Code, is amended by
  adding Sections 73.0111 and 73.012 to read as follows:
         Sec. 73.0111.  PROVIDER OMBUDSMAN. (a) In this section,
  "ombudsman" means the individual designated as the ombudsman for
  providers of services authorized under this chapter.
         (b)  The executive commissioner shall designate an ombudsman
  for providers of services authorized under this chapter.
         (c)  The ombudsman's office is administratively attached to
  the office of the ombudsman of the commission.
         (d)  The commission may use an alternate title for the
  ombudsman in provider-directed materials if the commission
  determines that the alternate title would benefit providers'
  understanding of or access to ombudsman services.
         (e)  The ombudsman serves as a neutral party to assist
  providers of services authorized under this chapter in resolving
  issues related to providing early childhood intervention services
  under this chapter, including through the STAR Kids managed care
  program.
         (f)  The ombudsman shall:
               (1)  provide dispute and complaint resolution
  services;
               (2)  perform provider protection and advocacy
  functions;
               (3)  collect inquiry and complaint data; and
               (4)  at least annually, submit a report to the
  commission relating to the inquiry and complaint data collected
  under Subdivision (3) and make recommendations to the commission on
  how to improve the provision of early childhood intervention
  services under this chapter.
         (g)  The executive commissioner by rule shall adopt and
  ensure the use of procedures for the reporting, monitoring, and
  resolution of disputes and complaints described by Subsection (f)
  that are consistent with the procedures adopted and used under
  Medicaid.
         Sec. 73.012.  GUIDANCE ON REIMBURSEMENT METHODOLOGY FOR CASE
  MANAGEMENT SERVICES. (a) The executive commissioner shall request
  clear direction and guidance from the federal Centers for Medicare
  and Medicaid Services on the reimbursement methodology that may be
  used for the provision of case management services under this
  chapter, including direction on allowable and unallowable costs.
         (b)  This section expires September 1, 2021.
         SECTION 3.  Subtitle B, Title 3, Human Resources Code, is
  amended by adding Chapter 74 to read as follows:
  CHAPTER 74. TELE-CONNECTIVE PILOT PROGRAM
         Sec. 74.0001.  DEFINITIONS. In this chapter:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Education service center region" means a
  geographic region served by a regional education service center
  under Chapter 8, Education Code.
               (3)  "Eligible child" means a child who is eligible for
  early childhood intervention services under Chapter 73.
               (4)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
               (5)  "Tele-connective pilot program" means the program
  developed and implemented under Section 74.0002.
               (6)  "Telehealth service" and "telemedicine medical
  service" have the meanings assigned by Section 111.001, Occupations
  Code.
         Sec. 74.0002.  TELE-CONNECTIVE PILOT PROGRAM. (a) The
  commission shall develop and implement a pilot program to provide
  early childhood intervention services under Chapter 73 to eligible
  children through the provision of telehealth and telemedicine
  medical services delivered using access points established in one
  or more education service center regions selected for
  implementation of the program.  Access points may be established:
               (1)  at schools, regional education service centers,
  and other entities located in an education service center region in
  which the program is implemented;
               (2)  in home-based settings; and
               (3)  through other modes the commission determines
  appropriate.
         (b)  In developing and implementing the tele-connective
  pilot program, the commission shall ensure the program aligns with
  the provision of existing telehealth and telemedicine medical
  services.
         Sec. 74.0003.  EDUCATION SERVICE CENTER REGION SELECTION.
  The commission in cooperation with the Texas Education Agency shall
  select the education service center regions in which to implement
  the tele-connective pilot program. In determining the regions in
  which to implement the program, the commission and the Texas
  Education Agency shall:
               (1)  consider each region in which there is:
                     (A)  a low or inadequate number of service
  providers authorized under Chapter 73; or
                     (B)  a significant risk of losing service
  providers authorized under Chapter 73; and
               (2)  implement the program only in regions in which the
  implementation is reasonable and feasible.
         Sec. 74.0004.  PROVIDER PARTICIPATION. (a) The commission
  shall ensure that all providers of services under Chapter 73,
  including school districts, are allowed to participate as providers
  in the tele-connective pilot program and provide services both
  inside and outside a school-based setting.
         (b)  The commission shall track the service hours of
  providers participating in the tele-connective pilot program.
         Sec. 74.0005.  ADEQUATE NETWORK OF ACCESS POINTS. (a) The
  commission, in consultation with the Texas Education Agency, shall:
               (1)  establish any school-based provider access points
  under the tele-connective pilot program; and
               (2)  ensure that an adequate number of school-based and
  non-school-based access points are established in education
  service center regions participating in the program.
         (b)  When selecting access points in which to implement the
  tele-connective pilot program, the commission and the Texas
  Education Agency shall consider the availability of existing
  infrastructure.
         Sec. 74.0006.  AUTOMATIC AND VOLUNTARY PARTICIPATION OF
  CERTAIN ELIGIBLE CHILDREN. (a) Subject to Subsection (b), the
  executive commissioner shall, after receiving recommendations from
  the advisory committee established under Section 73.004, by rule
  establish which eligible children will be automatically enrolled in
  the tele-connective pilot program.
         (b)  The parent, guardian, or other legally authorized
  representative of an eligible child may, at any time, elect to opt
  the child out of the tele-connective pilot program.
         (c)  A child who is enrolled in the tele-connective pilot
  program may receive early childhood intervention services through
  the program only to the extent the services are available and
  suitable. Enrollment in the tele-connective pilot program does not
  prevent a child from receiving early childhood intervention
  services in the child's home or other natural environment.
         Sec. 74.0007.  SCHOOL DISTRICT EMPLOYEE TRAINING. The Texas
  Education Agency shall develop a training course on the
  tele-connective pilot program to be given to appropriate school
  district employees.
         Sec. 74.0008.  INITIAL SCREENING AND EVALUATION. (a) The
  parent, guardian, or other legally authorized representative of an
  eligible child must be:
               (1)  present during an initial screening or evaluation
  under the tele-connective pilot program; and
               (2)  given the opportunity to opt the child out of the
  tele-connective pilot program at the time of the child's initial
  screening or evaluation.
         (b)  Notwithstanding any other law, after a child is enrolled
  in the tele-connective pilot program, early childhood intervention
  services, including any initial treatment or prescription, that are
  delivered or issued by a physician or by a health care provider
  acting under the delegation or supervision of the physician or
  under the health care provider's license may be provided using
  telecommunications or other information technology.
         Sec. 74.0009.  PROVIDER REIMBURSEMENT. The executive
  commissioner in adopting rules governing the tele-connective pilot
  program shall ensure that provider reimbursement for a telehealth
  or telemedicine medical service is made at a rate that is comparable
  to the rate paid under Medicaid for the provision of the same or
  substantially similar services.
         Sec. 74.0010.  CONFIDENTIALITY OF INFORMATION. The
  commission shall ensure that the tele-connective pilot program
  complies with federal and state law regarding confidentiality of
  medical information, including the Health Insurance Portability
  and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) and
  the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.
  Section 1232g).
         Sec. 74.0011.  ACCESS POINT EVALUATION. Not later than
  September 1, 2020, the commission shall conduct an evaluation of
  the tele-connective pilot program to ensure that an adequate number
  of access points have been established in each education service
  center region selected for implementation of the program. This
  section expires January 1, 2021.
         Sec. 74.0012.  REPORT. Not later than January 1, 2021, the
  commission shall submit an initial report to the governor, the
  lieutenant governor, the speaker of the house of representatives,
  and the presiding officers of the standing committees of the senate
  and house of representatives having primary jurisdiction over the
  early childhood intervention program authorized by Chapter 73. The
  report must evaluate the operation of the tele-connective pilot
  program and make recommendations regarding the continuation or
  expansion of the program.
         Sec. 74.0013.  FUNDING. The commission shall actively seek
  and apply for any available federal money to support the
  tele-connective pilot program, including federal money made
  available by the:
               (1)  Federal Communications Commission, including
  money available under the federal Rural Health Care Program;
               (2)  United States Health Resources and Services
  Administration's Office for the Advancement of Telehealth; and
               (3)  United States Department of Agriculture,
  including the Distance Learning and Telemedicine Grant Program
  established under 7 C.F.R. Part 1734.
         Sec. 74.0014.  EXPIRATION. This chapter expires September
  1, 2023.
         SECTION 4.  Subchapter A, Chapter 302, Labor Code, is
  amended by adding Section 302.0061 to read as follows:
         Sec. 302.0061.  WORKFORCE DEVELOPMENT GRANTS FOR PROVIDERS
  UNDER EARLY CHILDHOOD INTERVENTION PROGRAM. (a)  In this section,
  "early childhood intervention program" means the program
  established under Chapter 73, Human Resources Code, to provide
  early childhood intervention services in accordance with Part C,
  Individuals with Disabilities Education Act (IDEA)(20 U.S.C.
  Section 1431 et seq.).
         (b)  The commission shall actively seek and apply for federal
  funding to establish a program designed to provide workforce
  development grants to providers participating in the early
  childhood intervention program for purposes of improving the
  provision of program services by offering providers appropriate
  education and training.
         SECTION 5.  (a) The heading to Subchapter E, Chapter 1367,
  Insurance Code, is amended to read as follows:
  SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
  DEVELOPMENTAL DELAYS
         (b)  Section 1367.201, Insurance Code, is amended to read as
  follows:
         Sec. 1367.201.  DEFINITION. In this subchapter,
  rehabilitative and habilitative therapies and related services
  include:
               (1)  occupational therapy evaluations and services;
               (2)  physical therapy evaluations and services;
               (3)  speech therapy evaluations and services; [and]
               (4)  dietary or nutritional evaluations;
               (5)  specialized skills training by a person certified
  as an early intervention specialist;
               (6)  applied behavior analysis treatment by a licensed
  behavior analyst or licensed psychologist; and
               (7)  case management provided by a person certified as
  an early intervention specialist.
         (c)  Section 1367.202, Insurance Code, is amended to read as
  follows:
         Sec. 1367.202.  APPLICABILITY OF SUBCHAPTER. (a) This
  subchapter applies only to a health benefit plan that:
               (1)  provides benefits for medical or surgical expenses
  incurred as a result of a health condition, accident, or sickness,
  including an individual, group, blanket, or franchise insurance
  policy or insurance agreement, a group hospital service contract,
  or an individual or group evidence of coverage that is offered by:
                     (A)  an insurance company;
                     (B)  a group hospital service corporation
  operating under Chapter 842;
                     (C)  a fraternal benefit society operating under
  Chapter 885;
                     (D)  a stipulated premium company operating under
  Chapter 884;
                     (E)  a health maintenance organization operating
  under Chapter 843; or
                     (F)  a multiple employer welfare arrangement
  subject to regulation under Chapter 846;
               (2)  is offered by an approved nonprofit health
  corporation that holds a certificate of authority under Chapter
  844; or
               (3)  provides health and accident coverage through a
  risk pool created under Chapter 172, Local Government Code,
  notwithstanding Section 172.014, Local Government Code, or any
  other law.
         (b)  Notwithstanding any other law, this subchapter also
  applies to a standard health benefit plan provided under Chapter
  1507.
         (d)  Section 1367.203, Insurance Code, is amended to read as
  follows:
         Sec. 1367.203.  EXCEPTION. (a) This subchapter does not
  apply to:
               (1)  a plan that provides coverage:
                     (A)  only for a specified disease or for another
  limited benefit;
                     (B)  only for accidental death or dismemberment;
                     (C)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (D)  as a supplement to a liability insurance
  policy;
                     (E)  for credit insurance;
                     (F)  only for dental or vision care; or
                     (G)  only for indemnity for hospital confinement;
               (2)  a small employer health benefit plan written under
  Chapter 1501;
               (3)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
               (4)  a workers' compensation insurance policy;
               (5)  medical payment insurance coverage provided under
  a motor vehicle insurance policy; or
               (6)  a long-term care insurance policy, including a
  nursing home fixed indemnity policy, unless the commissioner
  determines that the policy provides benefit coverage so
  comprehensive that the policy is a health benefit plan as described
  by Section 1367.202.
         (b)  This subchapter does not apply to a qualified health
  plan to the extent that a determination is made under 45 C.F.R.
  Section 155.170 that:
               (1)  this subchapter requires the plan to offer
  benefits in addition to the essential health benefits required
  under 42 U.S.C. Section 18022(b); and
               (2)  this state is required to defray the cost of the
  benefits mandated under this subchapter.
         (e)  Section 1367.204, Insurance Code, is amended to read as
  follows:
         Sec. 1367.204.  PROVISION [OFFER] OF COVERAGE REQUIRED.
  [(a)] A health benefit plan issuer must provide [offer] coverage
  for rehabilitative and habilitative therapies and related services
  in accordance [that complies] with this subchapter.
         [(b)     The individual or group policy or contract holder may
  reject coverage required to be offered under this section.]
         (f)  Section 1367.205, Insurance Code, is amended by
  amending Subsections (a) and (b) and adding Subsection (d) to read
  as follows:
         (a)  A health benefit plan required to provide [that
  provides] coverage for rehabilitative and habilitative therapies
  and related services under this subchapter may not prohibit or
  restrict payment for covered services provided to a child and
  determined to be necessary to and provided in accordance with an
  individualized family service plan issued by the Health and Human
  Services Commission [Interagency Council on Early Childhood
  Intervention] under Chapter 73, Human Resources Code.
         (b)  Rehabilitative and habilitative therapies and related
  services described by Subsection (a) must be covered in the amount,
  duration, scope, and service setting established in the child's
  individualized family service plan.
         (d)  A health benefit plan prior authorization requirement,
  or another requirement that a service be authorized, otherwise
  applicable to a covered rehabilitative or habilitative therapy
  service or a related service is satisfied if the service is
  specified in a child's individualized family service plan.
         (g)  Subchapter E, Chapter 1367, Insurance Code, is amended
  by adding Section 1367.2055 to read as follows:
         Sec. 1367.2055.  MEDICAID PAY PARITY. A health benefit plan
  issuer shall reimburse a health care provider providing a
  rehabilitative and habilitative therapy or related service at a
  rate that is at least equal to the reimbursement rate the health
  care provider would receive for providing the same or a
  substantially similar service under Medicaid.
         (h)  Section 1367.206, Insurance Code, is amended to read as
  follows:
         Sec. 1367.206.  PROHIBITED ACTIONS. Under the coverage
  required to be provided [offered] under this subchapter, a health
  benefit plan issuer may not:
               (1)  apply the cost of rehabilitative and habilitative
  therapies and related services described by Section 1367.205(a) to
  an annual or lifetime maximum plan benefit or similar provision
  under the plan; or
               (2)  use the cost of rehabilitative or habilitative
  therapies and related services described by Section 1367.205(a) as
  the sole justification for:
                     (A)  increasing plan premiums; or
                     (B)  terminating the insured's or enrollee's
  participation in the plan.
         (i)  Section 1367.207, Insurance Code, is amended to read as
  follows:
         Sec. 1367.207.  RULES. (a) The commissioner may adopt rules
  necessary to implement this subchapter.
         (b)  Section 2001.0045, Government Code, does not apply to a
  rule adopted under this section.
         (j)  Subchapter E, Chapter 1367, Insurance Code, as amended
  by this section, applies only to a health benefit plan delivered,
  issued for delivery, or renewed on or after January 1, 2020. A
  health benefit plan delivered, issued for delivery, or renewed
  before January 1, 2020, is governed by the law as it existed
  immediately before the effective date of this Act, and that law is
  continued in effect for that purpose.
         SECTION 6.  (a) The Health and Human Services Commission
  shall request guidance from the federal Centers for Medicare and
  Medicaid Services or other appropriate federal agency regarding the
  feasibility of receiving a waiver or other authorization necessary
  to provide through Medicaid early childhood intervention services
  to children who are eligible to receive those services under
  Chapter 73, Human Resources Code, as amended by this Act, but who
  are not eligible for Medicaid and do not have private health
  benefits coverage.
         (b)  As soon as practicable after receiving guidance under
  Subsection (a) of this section, the Health and Human Services
  Commission shall prepare a report on how best to provide to children
  the coverage described by that subsection.  The commission shall
  submit the report to the governor, the lieutenant governor, the
  speaker of the house of representatives, and the presiding officers
  of the standing committees of the senate and house of
  representatives having primary jurisdiction over the early
  childhood intervention program authorized by Chapter 73, Human
  Resources Code, as amended by this Act.
         SECTION 7.  (a) As soon as practicable after the effective
  date of this Act, the Health and Human Services Commission, after
  consulting with the Texas Education Agency, other appropriate state
  agencies, and the advisory committee established under Section
  73.004, Human Resources Code, shall conduct a financial evaluation
  of the early childhood intervention services provided under Chapter
  73, Human Resources Code, as amended by this Act, and report on that
  evaluation. The report must quantify the amount by which providing
  early childhood intervention services in this state affects other
  budget strategies, including the budget strategies of school
  districts, regional education service centers, and other affected
  governmental entities.
         (b)  Not later than September 1, 2020, the Health and Human
  Services Commission shall submit the report prepared under
  Subsection (a) of this section to the governor, the lieutenant
  governor, the speaker of the house of representatives, and the
  presiding officers of the standing committees of the senate and
  house of representatives having primary jurisdiction over the early
  childhood intervention program authorized by Chapter 73, Human
  Resources Code, as amended by this Act.
         SECTION 8.  Not later than December 1, 2019, the Health and
  Human Services Commission shall issue guidance to health benefit
  plan issuers clarifying that providers of early childhood
  intervention services under Chapter 73, Human Resources Code, as
  amended by this Act, must file claims using the national provider
  identifier number and Texas provider identifier number.
         SECTION 9.  As soon as practicable after the effective date
  of this Act, but not later than January 1, 2020, the Health and
  Human Services Commission shall develop and implement the
  tele-connective pilot program required by Chapter 74, Human
  Resources Code, as added by this Act.
         SECTION 10.  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 11.  This Act takes effect September 1, 2019.
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