Bill Text: TX HB2590 | 2017-2018 | 85th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the administrative penalty, amelioration, and informal dispute resolution processes for providers participating in certain Medicaid waiver programs.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2017-06-09 - Effective on 9/1/17 [HB2590 Detail]
Download: Texas-2017-HB2590-Introduced.html
Bill Title: Relating to the administrative penalty, amelioration, and informal dispute resolution processes for providers participating in certain Medicaid waiver programs.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2017-06-09 - Effective on 9/1/17 [HB2590 Detail]
Download: Texas-2017-HB2590-Introduced.html
85R5422 JG-F | ||
By: Raymond | H.B. No. 2590 |
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relating to the amelioration and informal dispute resolution | ||
processes for providers participating in certain Medicaid waiver | ||
programs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter D, Chapter 161, Human Resources Code, | ||
is amended by adding Sections 161.0891 and 161.0892 to read as | ||
follows: | ||
Sec. 161.0891. AMELIORATION PROCESS. (a) In lieu of | ||
demanding payment of an administrative penalty assessed under | ||
Section 161.089, the commission may, in accordance with this | ||
section, allow the provider subject to the penalty to use, under the | ||
supervision of the commission, any portion of the amount of the | ||
penalty to ameliorate the violation or to improve services in the | ||
waiver program in which the provider participates. | ||
(b) The commission shall offer amelioration to a provider | ||
under this section not later than the 10th day after the date the | ||
provider receives from the commission a final notification of the | ||
assessment of an administrative penalty that is sent to the | ||
provider after an informal dispute resolution process but before an | ||
administrative hearing. | ||
(c) A provider to whom amelioration has been offered must | ||
file a plan for amelioration not later than the 45th day after the | ||
date the provider receives the offer of amelioration from the | ||
commission. In submitting the plan, the provider must agree to | ||
waive the provider's right to an administrative hearing if the | ||
commission approves the plan. | ||
(d) At a minimum, a plan for amelioration must: | ||
(1) propose changes to the management or operation of | ||
the waiver program in which the provider participates that will | ||
improve services to or quality of care for clients in the program; | ||
(2) identify, through measurable outcomes, the ways in | ||
which and the extent to which the proposed changes will improve | ||
services to or quality of care for clients in the waiver program; | ||
(3) establish clear goals to be achieved through the | ||
proposed changes; | ||
(4) establish a timeline for implementing the proposed | ||
changes; and | ||
(5) identify specific actions necessary to implement | ||
the proposed changes. | ||
(e) The commission may require that an amelioration plan | ||
propose changes that would result in conditions that exceed the | ||
requirements of a law or rule relating to the waiver program in | ||
which the provider participates. | ||
(f) The commission shall approve or deny an amelioration | ||
plan not later than the 45th day after the date the commission | ||
receives the plan. On approval of a provider's plan, the commission | ||
or the State Office of Administrative Hearings, as appropriate, | ||
shall deny a pending request for a hearing submitted by the | ||
provider. | ||
(g) The commission may not offer amelioration to a provider: | ||
(1) more than three times in a two-year period; or | ||
(2) more than one time in a two-year period for the | ||
same or similar violation. | ||
Sec. 161.0892. INFORMAL DISPUTE RESOLUTION. (a) The | ||
executive commissioner by rule shall establish an informal dispute | ||
resolution process in accordance with this section. The process | ||
must provide for adjudication by an appropriate disinterested | ||
person of disputes relating to a proposed enforcement action or | ||
related proceeding of the commission against a provider | ||
participating in a waiver program described by Section 161.089. | ||
The informal dispute resolution process must require: | ||
(1) a provider participating in a waiver program | ||
described by Section 161.089 to request informal dispute resolution | ||
not later than the 10th calendar day after the date of notification | ||
by the commission of the violation of a law or rule relating to the | ||
program; and | ||
(2) the commission to complete the process not later | ||
than the 30th calendar day after the date of receipt of a request | ||
from a provider for informal dispute resolution. | ||
(b) As part of the informal dispute resolution process | ||
established under this section, the commission shall contract with | ||
an appropriate disinterested person who is a nonprofit organization | ||
to adjudicate disputes between a provider participating in a | ||
program described by Section 161.089 and the commission concerning | ||
a statement of violations prepared by the commission. Section | ||
2009.053, Government Code, does not apply to the selection of an | ||
appropriate disinterested person under this subsection. The person | ||
with whom the commission contracts shall adjudicate all disputes | ||
described by this subsection. | ||
(c) The executive commissioner shall adopt rules to | ||
adjudicate claims in contested cases. | ||
(d) The commission may not delegate its responsibility to | ||
administer the informal dispute resolution process established by | ||
this section to another state agency. | ||
SECTION 2. Subchapter D, Chapter 161, Human Resources Code, | ||
is amended by adding Sections 161.0881 and 161.0882 to read as | ||
follows: | ||
Sec. 161.0881. AMELIORATION PROCESS. (a) In lieu of | ||
demanding payment of an administrative penalty assessed under | ||
Section 161.088, the commission may, in accordance with this | ||
section, allow the provider subject to the penalty to use, under the | ||
supervision of the commission, any portion of the amount of the | ||
penalty to ameliorate the violation or to improve services in the | ||
waiver program in which the provider participates. | ||
(b) The commission shall offer amelioration to a provider | ||
under this section not later than the 10th day after the date the | ||
provider receives from the commission a final notification of the | ||
assessment of an administrative penalty that is sent to the | ||
provider after an informal dispute resolution process but before an | ||
administrative hearing. | ||
(c) A provider to whom amelioration has been offered must | ||
file a plan for amelioration not later than the 45th day after the | ||
date the provider receives the offer of amelioration from the | ||
commission. In submitting the plan, the provider must agree to | ||
waive the provider's right to an administrative hearing if the | ||
commission approves the plan. | ||
(d) At a minimum, a plan for amelioration must: | ||
(1) propose changes to the management or operation of | ||
the waiver program in which the provider participates that will | ||
improve services to or quality of care for clients in the program; | ||
(2) identify, through measurable outcomes, the ways in | ||
which and the extent to which the proposed changes will improve | ||
services to or quality of care for clients in the waiver program; | ||
(3) establish clear goals to be achieved through the | ||
proposed changes; | ||
(4) establish a timeline for implementing the proposed | ||
changes; and | ||
(5) identify specific actions necessary to implement | ||
the proposed changes. | ||
(e) The commission may require that an amelioration plan | ||
propose changes that would result in conditions that exceed the | ||
requirements of a law or rule relating to the waiver program in | ||
which the provider participates. | ||
(f) The commission shall approve or deny an amelioration | ||
plan not later than the 45th day after the date the commission | ||
receives the plan. On approval of a provider's plan, the commission | ||
or the State Office of Administrative Hearings, as appropriate, | ||
shall deny a pending request for a hearing submitted by the | ||
provider. | ||
(g) The commission may not offer amelioration to a provider: | ||
(1) more than three times in a two-year period; or | ||
(2) more than one time in a two-year period for the | ||
same or similar violation. | ||
Sec. 161.0882. INFORMAL DISPUTE RESOLUTION. (a) The | ||
executive commissioner by rule shall establish an informal dispute | ||
resolution process in accordance with this section. The process | ||
must provide for adjudication by an appropriate disinterested | ||
person of disputes relating to a proposed enforcement action or | ||
related proceeding of the commission against a provider | ||
participating in a waiver program described by Section 161.088. | ||
The informal dispute resolution process must require: | ||
(1) a provider participating in a waiver program | ||
described by Section 161.088 to request informal dispute resolution | ||
not later than the 10th calendar day after the date of notification | ||
by the commission of the violation of a law or rule relating to the | ||
program; and | ||
(2) the commission to complete the process not later | ||
than the 30th calendar day after the date of receipt of a request | ||
from a provider for informal dispute resolution. | ||
(b) As part of the informal dispute resolution process | ||
established under this section, the commission shall contract with | ||
an appropriate disinterested person who is a nonprofit organization | ||
to adjudicate disputes between a provider participating in a | ||
program described by Section 161.088 and the commission concerning | ||
a statement of violations prepared by the commission. Section | ||
2009.053, Government Code, does not apply to the selection of an | ||
appropriate disinterested person under this subsection. The person | ||
with whom the commission contracts shall adjudicate all disputes | ||
described by this subsection. | ||
(c) The executive commissioner shall adopt rules to | ||
adjudicate claims in contested cases. | ||
(d) The commission may not delegate its responsibility to | ||
administer the informal dispute resolution process established by | ||
this section to another state agency. | ||
SECTION 3. (a) Section 1 of this Act takes effect only if | ||
the Act of the 85th Legislature, Regular Session, 2017, relating to | ||
nonsubstantive additions to and corrections in enacted codes | ||
becomes law. | ||
(b) Section 2 of this Act takes effect only if the Act of the | ||
85th Legislature, Regular Session, 2017, relating to | ||
nonsubstantive additions to and corrections in enacted codes does | ||
not become law. | ||
SECTION 4. As soon as practicable after the effective date | ||
of this Act, the executive commissioner of the Health and Human | ||
Services Commission shall adopt the rules necessary to implement | ||
the changes in law made by this Act. | ||
SECTION 5. This Act takes effect September 1, 2017. |