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 - Dead) 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. |
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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 [ |
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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 [ |
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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; [ |
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(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 [ |
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[ |
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for rehabilitative and habilitative therapies and related services | ||
in accordance [ |
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[ |
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(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 [ |
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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 [ |
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(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 [ |
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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. |