Bill Text: TX HB4533 | 2019-2020 | 86th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the administration and operation of Medicaid, including Medicaid managed care and the delivery of Medicaid acute care services and long-term services and supports to certain persons.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Passed) 2019-06-14 - Effective on 9/1/19 [HB4533 Detail]
Download: Texas-2019-HB4533-Introduced.html
Bill Title: Relating to the administration and operation of Medicaid, including Medicaid managed care and the delivery of Medicaid acute care services and long-term services and supports to certain persons.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Passed) 2019-06-14 - Effective on 9/1/19 [HB4533 Detail]
Download: Texas-2019-HB4533-Introduced.html
86R13606 JG-F | ||
By: Klick | H.B. No. 4533 |
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relating to the system redesign for delivery of Medicaid acute care | ||
services and long-term services and supports to persons with an | ||
intellectual or developmental disability. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 534.001, Government Code, is amended by | ||
amending Subdivision (3) and adding Subdivision (11-a) to read as | ||
follows: | ||
(3) "Comprehensive long-term services and supports | ||
provider" means a provider of long-term services and supports under | ||
this chapter that ensures the coordinated, seamless delivery of the | ||
full range of services in a recipient's program plan. The term | ||
includes: | ||
(A) a provider under the ICF-IID program; and | ||
(B) a provider under a Medicaid waiver program | ||
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(11-a) "Residential services" means services provided | ||
to an individual with an intellectual or developmental disability | ||
through a community-based ICF-IID or three- or four-person home or | ||
host home setting under the home and community-based services (HCS) | ||
waiver program. | ||
SECTION 2. Sections 534.051 and 534.052, Government Code, | ||
are amended to read as follows: | ||
Sec. 534.051. ACUTE CARE SERVICES AND LONG-TERM SERVICES | ||
AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR | ||
DEVELOPMENTAL DISABILITY. In accordance with this chapter, the | ||
commission [ |
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implement an acute care services and long-term services and | ||
supports system for individuals with an intellectual or | ||
developmental disability that supports the following goals: | ||
(1) provide Medicaid services to more individuals in a | ||
cost-efficient manner by providing the type and amount of services | ||
most appropriate to the individuals' needs; | ||
(2) improve individuals' access to services and | ||
supports by ensuring that the individuals receive information about | ||
all available programs and services, including employment and least | ||
restrictive housing assistance, and how to apply for the programs | ||
and services; | ||
(3) improve the assessment of individuals' needs and | ||
available supports, including the assessment of individuals' | ||
functional needs; | ||
(4) promote person-centered planning, self-direction, | ||
self-determination, community inclusion, and customized, | ||
integrated, competitive employment; | ||
(5) promote individualized budgeting based on an | ||
assessment of an individual's needs and person-centered planning; | ||
(6) promote integrated service coordination of acute | ||
care services and long-term services and supports; | ||
(7) improve acute care and long-term services and | ||
supports outcomes, including reducing unnecessary | ||
institutionalization and potentially preventable events; | ||
(8) promote high-quality care; | ||
(9) provide fair hearing and appeals processes in | ||
accordance with applicable federal law; | ||
(10) ensure the availability of a local safety net | ||
provider and local safety net services; | ||
(11) promote independent service coordination and | ||
independent ombudsmen services; and | ||
(12) ensure that individuals with the most significant | ||
needs are appropriately served in the community and that processes | ||
are in place to prevent inappropriate institutionalization of | ||
individuals. | ||
Sec. 534.052. IMPLEMENTATION OF SYSTEM REDESIGN. The | ||
commission [ |
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collaboration with the advisory committee, [ |
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acute care services and long-term services and supports system for | ||
individuals with an intellectual or developmental disability in the | ||
manner and in the stages described in this chapter. | ||
SECTION 3. Section 534.053, Government Code, is amended by | ||
amending Subsections (a) and (b) and adding Subsection (f-1) to | ||
read as follows: | ||
(a) The Intellectual and Developmental Disability System | ||
Redesign Advisory Committee shall advise the commission [ |
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long-term services and supports system redesign under this | ||
chapter. Subject to Subsection (b), the executive commissioner | ||
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stakeholders from the intellectual and developmental disabilities | ||
community, including: | ||
(1) individuals with an intellectual or developmental | ||
disability who are recipients of services under the Medicaid waiver | ||
programs, individuals with an intellectual or developmental | ||
disability who are recipients of services under the ICF-IID | ||
program, and individuals who are advocates of those recipients, | ||
including at least three representatives from intellectual and | ||
developmental disability advocacy organizations; | ||
(2) representatives of Medicaid managed care and | ||
nonmanaged care health care providers, including: | ||
(A) physicians who are primary care providers and | ||
physicians who are specialty care providers; | ||
(B) nonphysician mental health professionals; | ||
and | ||
(C) providers of long-term services and | ||
supports, including direct service workers; | ||
(3) representatives of entities with responsibilities | ||
for the delivery of Medicaid long-term services and supports or | ||
other Medicaid service delivery, including: | ||
(A) representatives of aging and disability | ||
resource centers established under the Aging and Disability | ||
Resource Center initiative funded in part by the federal | ||
Administration on Aging and the Centers for Medicare and Medicaid | ||
Services; | ||
(B) representatives of community mental health | ||
and intellectual disability centers; | ||
(C) representatives of and service coordinators | ||
or case managers from private and public home and community-based | ||
services providers that serve individuals with an intellectual or | ||
developmental disability; and | ||
(D) representatives of private and public | ||
ICF-IID providers; and | ||
(4) representatives of managed care organizations | ||
contracting with the state to provide services to individuals with | ||
an intellectual or developmental disability. | ||
(b) To the greatest extent possible, the executive | ||
commissioner [ |
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reflect the geographic diversity of the state and include members | ||
who represent rural Medicaid recipients. | ||
(f-1) The advisory committee is abolished January 1, 2029, | ||
unless the commission makes a determination under Section 534.202 | ||
to not proceed with the transition described by that section and to | ||
abolish the advisory committee on an earlier date. If the | ||
commission makes that determination, the commission shall publish | ||
notice of the determination in the Texas Register not later than 30 | ||
days after making the determination. The notice must specify a date | ||
not later than January 1, 2029, on which the advisory committee is | ||
abolished. | ||
SECTION 4. Section 534.053(g), Government Code, as amended | ||
by Chapters 837 (S.B. 200), 946 (S.B. 277), and 1117 (H.B. 3523), | ||
Acts of the 84th Legislature, Regular Session, 2015, is reenacted | ||
and amended to read as follows: | ||
(g) This section expires [ |
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SECTION 5. Section 534.054, Government Code, is amended by | ||
amending Subsection (b) and adding Subsection (c) to read as | ||
follows: | ||
(b) If the commission makes a determination under Section | ||
534.202 to not proceed with the transition described by that | ||
section, the commission shall publish notice of the determination | ||
in the Texas Register not later than 30 days after making the | ||
determination. Notwithstanding Subsection (a), the commission is | ||
not required to submit the report under that subsection after | ||
publishing the notice under this subsection. | ||
(c) This section expires January 1, 2029 [ |
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SECTION 6. The heading to Subchapter C, Chapter 534, | ||
Government Code, is amended to read as follows: | ||
SUBCHAPTER C. STAGE ONE: PILOT PROGRAM FOR IMPROVING [ |
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SECTION 7. Section 534.101, Government Code, is amended by | ||
amending Subdivision (2) and adding Subdivision (3) to read as | ||
follows: | ||
(2) "Health care service region" has the meaning | ||
assigned by Section 533.001 [ |
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(3) "Pilot program" means the pilot program | ||
established under this subchapter. | ||
SECTION 8. Sections 534.102 and 534.103, Government Code, | ||
are amended to read as follows: | ||
Sec. 534.102. PILOT PROGRAM [ |
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STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION. The commission, | ||
in consultation and collaboration with the advisory committee, | ||
shall [ |
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program [ |
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through the STAR+PLUS Medicaid managed care program, the delivery | ||
of home and community-based services [ |
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subject to Section 534.1065. | ||
Sec. 534.103. STAKEHOLDER INPUT. As part of developing and | ||
implementing the [ |
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commission, in consultation and collaboration with the advisory | ||
committee, [ |
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evaluate: | ||
(1) input from statewide stakeholders and | ||
stakeholders from a health care service [ |
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in which the pilot program will be implemented; and | ||
(2) other evaluations and data. | ||
SECTION 9. The heading to Section 534.104, Government Code, | ||
is amended to read as follows: | ||
Sec. 534.104. SELECTION OF [ |
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SECTION 10. Sections 534.104(a), (b), (c), (f), (g), and | ||
(h), Government Code, are amended to read as follows: | ||
(a) The commission shall select and contract with one or | ||
more managed care organizations participating in the STAR+PLUS | ||
Medicaid managed care program to participate in the pilot program. | ||
(b) The commission [ |
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collaboration with the advisory committee, shall develop criteria | ||
regarding the selection of one or more managed care organizations | ||
to participate in the pilot program [ |
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(c) The [ |
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(1) increase access to home and community-based | ||
services [ |
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(2) improve quality of acute care services and home | ||
and community-based services [ |
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(3) promote meaningful outcomes by using | ||
person-centered planning, individualized budgeting, and | ||
self-determination, and promote community inclusion; | ||
(4) promote integrated service coordination of acute | ||
care services and home and community-based services [ |
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(5) promote efficiency and the best use of funding; | ||
(6) promote [ |
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housing stability through housing supports and navigation services | ||
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(7) promote employment assistance and customized, | ||
integrated, and competitive employment; | ||
(8) provide fair hearing and appeals processes in | ||
accordance with applicable federal law; [ |
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(9) promote sufficient flexibility to achieve the | ||
goals listed in this section through the pilot program; | ||
(10) promote the use of innovative technology and | ||
benefits, including home monitoring, telemonitoring, | ||
transportation, and other innovations that support community | ||
integration; | ||
(11) ensure an adequate provider network that includes | ||
comprehensive long-term services and supports providers; and | ||
(12) ensure that individuals with complex behavioral, | ||
medical, and physical needs are appropriately served. | ||
(f) A managed care organization participating in the [ |
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supports under Medicaid to persons with an intellectual or | ||
developmental disability to test its managed care strategy based on | ||
capitation. | ||
(g) The commission [ |
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collaboration with the advisory committee, shall analyze | ||
information provided by the managed care organizations | ||
participating in the pilot program [ |
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information collected by the commission [ |
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operation of the pilot program [ |
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recommendation about a system of programs and services for | ||
implementation through future state legislation or rules. | ||
(h) The analysis under Subsection (g) must include an | ||
assessment of the effect of the managed care strategies implemented | ||
in the pilot program [ |
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provided under Subsection (f) [ |
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SECTION 11. Subchapter C, Chapter 534, Government Code, is | ||
amended by adding Section 534.1045 to read as follows: | ||
Sec. 534.1045. PILOT PROGRAM BENEFITS PROVIDED. The pilot | ||
program must ensure that a managed care organization participating | ||
in the pilot program provides: | ||
(1) all Medicaid state plan benefits available under | ||
the STAR+PLUS program, including: | ||
(A) acute care services, including physical | ||
health, behavioral health, specialty care, inpatient hospital, and | ||
outpatient pharmacy services; and | ||
(B) long-term services and supports, including: | ||
(i) Community First Choice services; | ||
(ii) personal assistance services; | ||
(iii) day activity health services; | ||
(iv) habilitation services; and | ||
(v) home and community-based services, | ||
including assisted living, personal assistance services, | ||
employment assistance, supported employment, adult foster care, | ||
dental care, nursing care, respite care, home-delivered meals, and | ||
therapy services; | ||
(2) the following additional home and community-based | ||
services: | ||
(A) enhanced behavioral health services; | ||
(B) behavioral supports; | ||
(C) day habilitation; | ||
(D) housing supports; | ||
(E) community support transportation; and | ||
(F) crisis intervention services; and | ||
(3) other home and community-based services the | ||
commission, in consultation and coordination with the advisory | ||
committee, determines appropriate. | ||
SECTION 12. Sections 534.105, 534.106, 534.1065, 534.107, | ||
534.109, and 534.111, Government Code, are amended to read as | ||
follows: | ||
Sec. 534.105. PILOT PROGRAM: MEASURABLE GOALS. (a) The | ||
commission [ |
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the advisory committee, shall identify measurable goals to be | ||
achieved by the [ |
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(b) The commission [ |
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collaboration with the advisory committee, shall develop [ |
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specific strategies for achieving the identified goals. A proposed | ||
strategy may be evidence-based if there is an evidence-based | ||
strategy available for meeting the pilot program's goals. | ||
Sec. 534.106. IMPLEMENTATION, LOCATION, AND DURATION. (a) | ||
The commission [ |
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program [ |
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September 1, 2023 [ |
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(b) The [ |
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(c) The [ |
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regions selected by the commission [ |
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Sec. 534.1065. RECIPIENT PARTICIPATION AND ELIGIBILITY [ |
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[ |
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decision whether to participate in the pilot [ |
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receive [ |
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the individual's legally authorized representative. | ||
(b) The commission, in consultation and coordination with | ||
the advisory committee, shall develop pilot program participant | ||
eligibility criteria, including financial and functional need | ||
criteria. The criteria must ensure pilot program participants: | ||
(1) include: | ||
(A) individuals with an intellectual or | ||
developmental disability who: | ||
(i) have significant complex behavioral, | ||
medical, and physical needs; | ||
(ii) are receiving home and community-based | ||
services through the STAR+PLUS Medicaid managed care program; or | ||
(iii) are on a Medicaid waiver program | ||
interest list; | ||
(B) individuals receiving services under the | ||
STAR+PLUS Medicaid managed care program who have a traumatic brain | ||
injury that occurred after the age of 21; and | ||
(C) other populations determined by the | ||
commission; 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. | ||
(c) Individuals who choose to participate in the pilot | ||
program and who, during the pilot program's implementation, are | ||
offered enrollment in a Medicaid waiver program may accept the | ||
enrollment offer. | ||
Sec. 534.107. COMMISSION RESPONSIBILITIES [ |
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require that a managed care organization participating in the pilot | ||
program: | ||
(1) ensures that individuals participating in the | ||
pilot program have a choice among acute care and comprehensive | ||
long-term services and supports providers and service delivery | ||
options, including the consumer direction model, as defined by | ||
Section 531.051 [ |
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(2) demonstrates to the commission's satisfaction that | ||
the organization's network of acute care and comprehensive | ||
long-term services and supports providers have experience and | ||
expertise in providing services for individuals with an | ||
intellectual or developmental disability [ |
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(3) has [ |
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institutionalizations of individuals[ |
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(b) For purposes of the pilot program, the commission shall | ||
ensure that comprehensive long-term services and supports | ||
providers are considered significant traditional providers and | ||
included in the provider network of the managed care organizations | ||
participating in the pilot program. | ||
Sec. 534.109. PERSON-CENTERED PLANNING. The commission, | ||
in consultation and collaboration [ |
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committee [ |
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intellectual or developmental disability who receives services and | ||
supports under Medicaid through the [ |
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representative, has access to a facilitated, person-centered plan | ||
that identifies outcomes for the individual and drives the | ||
development of the individualized budget. The consumer direction | ||
model, as defined by Section 531.051, must be an available option | ||
for individuals to achieve self-determination, choice, and control | ||
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Sec. 534.111. CONCLUSION OF PILOT PROGRAM [ |
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EXPIRATION. On September 1, 2025 [ |
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(1) the [ |
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(2) this subchapter expires. | ||
SECTION 13. Section 534.151(b), Government Code, is amended | ||
to read as follows: | ||
(b) The commission [ |
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and collaboration with the advisory committee, shall analyze the | ||
outcomes of providing acute care Medicaid benefits to individuals | ||
with an intellectual or developmental disability under a model | ||
specified in Subsection (a). The analysis must: | ||
(1) include an assessment of the effects on: | ||
(A) access to and quality of acute care services; | ||
and | ||
(B) the number and types of fair hearing and | ||
appeals processes in accordance with applicable federal law; | ||
(2) be incorporated into the annual report to the | ||
legislature required under Section 534.054; and | ||
(3) include recommendations for delivery model | ||
improvements and implementation for consideration by the | ||
legislature, including recommendations for needed statutory | ||
changes. | ||
SECTION 14. Sections 534.152(b), (c), (f), and (g), | ||
Government Code, are amended to read as follows: | ||
(b) The commission shall require that each managed care | ||
organization that contracts with the commission for the provision | ||
of basic attendant and habilitation services under the STAR+PLUS | ||
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section: | ||
(1) include in the organization's provider network for | ||
the provision of those services: | ||
(A) home and community support services agencies | ||
licensed under Chapter 142, Health and Safety Code, with which | ||
there is [ |
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the community living assistance and support services (CLASS) waiver | ||
program; and | ||
(B) persons exempted from licensing under | ||
Section 142.003(a)(19), Health and Safety Code, with which there is | ||
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(i) the home and community-based services | ||
(HCS) waiver program; or | ||
(ii) the Texas home living (TxHmL) waiver | ||
program; | ||
(2) review and consider any assessment conducted by a | ||
local intellectual and developmental disability authority | ||
providing intellectual and developmental disability service | ||
coordination under Subsection (c); and | ||
(3) enter into a written agreement with each local | ||
intellectual and developmental disability authority in the service | ||
area regarding the processes the organization and the authority | ||
will use to coordinate the services of individuals with an | ||
intellectual or developmental disability. | ||
(c) The commission [ |
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make contract payments to local intellectual and developmental | ||
disability authorities to conduct the following activities under | ||
this section: | ||
(1) provide intellectual and developmental disability | ||
service coordination to individuals with an intellectual or | ||
developmental disability under the STAR+PLUS [ |
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managed care program by assisting those individuals who are | ||
eligible to receive services in a community-based setting, | ||
including individuals transitioning to a community-based setting; | ||
(2) provide an assessment to the appropriate managed | ||
care organization regarding whether an individual with an | ||
intellectual or developmental disability needs attendant or | ||
habilitation services, based on the individual's functional need, | ||
risk factors, and desired outcomes; | ||
(3) assist individuals with an intellectual or | ||
developmental disability with developing the individuals' plans of | ||
care under the STAR+PLUS [ |
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program, including with making any changes resulting from periodic | ||
reassessments of the plans; | ||
(4) provide to the appropriate managed care | ||
organization [ |
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recommended plans of care with which the authorities provide | ||
assistance as provided by Subdivision (3), including documentation | ||
necessary to demonstrate the need for care described by a plan; and | ||
(5) on an annual basis, provide to the appropriate | ||
managed care organization [ |
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outcomes based on an individual's plan of care. | ||
(f) A local intellectual and developmental disability | ||
authority with which the commission [ |
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Subsection (c) may subcontract with an eligible person, including a | ||
nonprofit entity, to coordinate the services of individuals with an | ||
intellectual or developmental disability under this section. The | ||
executive commissioner by rule shall establish minimum | ||
qualifications a person must meet to be considered an "eligible | ||
person" under this subsection. | ||
(g) The commission [ |
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participating in the home and community-based services (HCS) waiver | ||
program, the Texas home living (TxHmL) waiver program, the | ||
community living assistance and support services (CLASS) waiver | ||
program, or the deaf-blind with multiple disabilities (DBMD) waiver | ||
program for the delivery of basic attendant and habilitation | ||
services described in Subsection (a) for individuals to which that | ||
subsection applies. The commission [ |
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oversight authority over the providers with which the commission | ||
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SECTION 15. The heading to Subchapter E, Chapter 534, | ||
Government Code, is amended to read as follows: | ||
SUBCHAPTER E. STAGE TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS | ||
AND LONG-TERM CARE MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED | ||
MANAGED CARE SYSTEM | ||
SECTION 16. The heading to Section 534.201, Government | ||
Code, is amended to read as follows: | ||
Sec. 534.201. EVALUATION AND REPORT ON PILOT PROGRAM | ||
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SECTION 17. Sections 534.201(a), (b), and (g), Government | ||
Code, are amended to read as follows: | ||
(a) The commission, in consultation and collaboration with | ||
the advisory committee, shall review and evaluate the progress and | ||
outcomes of the pilot program established under Subchapter C and | ||
submit, as part of the annual report required by Section 534.054, a | ||
report on the status of the pilot program. The report must include | ||
recommendations for pilot program improvement [ |
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(b) On conclusion of the pilot program established under | ||
Subchapter C, the commission, in consultation and collaboration | ||
with the advisory committee, shall conduct a comprehensive analysis | ||
of the pilot program's success and prepare and submit to the | ||
legislature a report based on that analysis [ |
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(g) The comprehensive [ |
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Subsection (b) must: | ||
(1) include an assessment of the effect of the pilot | ||
program [ |
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(A) access to long-term services and supports; | ||
(B) meaningful outcomes using person-centered | ||
planning, individualized budgeting, and self-determination, | ||
including a person's inclusion in the community; | ||
(C) the integration of service coordination of | ||
acute care services and long-term services and supports; | ||
(D) employment assistance and customized, | ||
integrated, competitive employment options; and | ||
(E) the number and types of fair hearing and | ||
appeals processes in accordance with applicable federal law; | ||
(2) provide an analysis of the experience and outcome | ||
of the following systems changes: | ||
(A) the comprehensive assessment instrument | ||
described by Section 533A.0335, Health and Safety Code; | ||
(B) the 21st Century Cures Act (Pub. L. | ||
No. 114-255); | ||
(C) implementation of the federal rule | ||
establishing the home and community-based settings that are | ||
eligible for reimbursement under the STAR+PLUS home and | ||
community-based services (HCBS) waiver program; and | ||
(D) the provision of basic attendant and | ||
habilitation services under Section 534.152; | ||
(3) include input from individuals and comprehensive | ||
long-term services and supports providers who participated in the | ||
pilot program about their experiences; | ||
(4) be incorporated into the annual report to the | ||
legislature required under Section 534.054; and | ||
(5) [ |
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programs and services [ |
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recommendations for needed statutory changes. | ||
SECTION 18. The heading to Section 534.202, Government | ||
Code, is amended to read as follows: | ||
Sec. 534.202. DETERMINATION TO TRANSITION [ |
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PROGRAM RECIPIENTS AND CERTAIN OTHER MEDICAID WAIVER PROGRAM | ||
RECIPIENTS TO MANAGED CARE PROGRAM. | ||
SECTION 19. Sections 534.202(a), (b), (c), (e), and (i), | ||
Government Code, are amended to read as follows: | ||
(a) This section applies to individuals with an | ||
intellectual or developmental disability who[ |
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are receiving long-term services and supports under: | ||
(1) a Medicaid waiver program [ |
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(2) an ICF-IID program. | ||
(b) After completing the comprehensive analysis under | ||
[ |
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[ |
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whether to: | ||
(1) establish a new pilot program to test the | ||
provision of residential services to individuals with an | ||
intellectual or developmental disability under the managed care | ||
program; or | ||
(2) transition ICF-IID and other Medicaid waiver | ||
program recipients to the managed care program delivery model for | ||
the provision of long-term supports and services [ |
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(c) If the commission determines to [ |
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transition the provision of benefits as described by Subsection | ||
(b), the commission shall, not later than September 1, 2027, and | ||
subject to Subsection (g), determine whether to: | ||
(1) continue operation of the Medicaid waiver programs | ||
or ICF-IID program only for purposes of providing, if applicable: | ||
(A) supplemental long-term services and supports | ||
not available under the managed care program delivery model | ||
selected by the commission; or | ||
(B) long-term services and supports to Medicaid | ||
waiver program recipients who choose to continue receiving benefits | ||
under the waiver programs [ |
||
or | ||
(2) [ |
||
portion of the long-term services and supports previously available | ||
under the Medicaid waiver programs or ICF-IID program through the | ||
managed care program delivery model selected by the commission. | ||
(e) The commission shall ensure that there is a | ||
comprehensive plan for transitioning the provision of Medicaid | ||
benefits under this section that protects the continuity of care | ||
provided to individuals to whom this section applies and ensures | ||
individuals have a choice among acute care and comprehensive | ||
long-term services and supports providers and service delivery | ||
options, including the consumer direction model, as defined by | ||
Section 531.051. | ||
(i) In addition to the requirements of Section 533.005, a | ||
contract between a managed care organization and the commission for | ||
the organization to provide Medicaid benefits under this section | ||
must contain a requirement that the organization implement a | ||
process for individuals with an intellectual or developmental | ||
disability that: | ||
(1) ensures that the individuals have a choice among | ||
acute care and comprehensive long-term services and supports | ||
providers and service delivery options, including the consumer | ||
direction model, as defined by Section 531.051; | ||
(2) to the greatest extent possible, protects those | ||
individuals' continuity of care with respect to access to primary | ||
care providers, including the use of single-case agreements with | ||
out-of-network providers; and | ||
(3) provides access to a member services phone line | ||
for individuals or their legally authorized representatives to | ||
obtain information on and assistance with accessing services | ||
through network providers, including providers of primary, | ||
specialty, and other long-term services and supports. | ||
SECTION 20. Section 534.203, Government Code, is amended to | ||
read as follows: | ||
Sec. 534.203. RESPONSIBILITIES OF COMMISSION UNDER | ||
SUBCHAPTER. In administering this subchapter, the commission shall | ||
ensure: | ||
(1) that the commission is responsible for setting the | ||
minimum reimbursement rate paid to a provider of ICF-IID services | ||
or a group home provider under the integrated managed care system, | ||
including the staff rate enhancement paid to a provider of ICF-IID | ||
services or a group home provider; | ||
(2) that an ICF-IID service provider or a group home | ||
provider is paid not later than the 10th day after the date the | ||
provider submits a clean claim in accordance with the criteria used | ||
by the commission [ |
||
service providers or a group home provider, as applicable; [ |
||
(3) the establishment of an electronic portal through | ||
which a provider of ICF-IID services or a group home provider | ||
participating in the STAR+PLUS [ |
||
program delivery model or the most appropriate integrated capitated | ||
managed care program delivery model, as appropriate, may submit | ||
long-term services and supports claims to any participating managed | ||
care organization; and | ||
(4) that the consumer direction model, as defined by | ||
Section 531.051, is an available option for each individual with an | ||
intellectual or developmental disability who receives Medicaid | ||
benefits in accordance with this subchapter to achieve | ||
self-determination, choice, and control, and that the individual or | ||
the individual's legally authorized representative has access to a | ||
facilitated, person-centered plan that identifies outcomes for the | ||
individual. | ||
SECTION 21. Chapter 534, Government Code, is amended by | ||
adding Subchapter F to read as follows: | ||
SUBCHAPTER F. IMPLEMENTATION AND TRANSITION OF SERVICES | ||
Sec. 534.251. DELAYED IMPLEMENTATION AUTHORIZED. | ||
Notwithstanding any other law, the commission may delay | ||
implementation of a provision of this chapter if the commission | ||
determines the provision adversely affects the system of services | ||
and supports to persons and programs to which this chapter applies. | ||
Sec. 534.252. REQUIREMENTS REGARDING TRANSITION OF | ||
SERVICES. For purposes of implementing the pilot program under | ||
Subchapter C and transitioning the provision of long-term services | ||
and supports to recipients to a Medicaid managed care delivery | ||
model following completion of the pilot program, the commission | ||
shall: | ||
(1) implement and maintain a credentialing process for | ||
and maintain regulatory oversight over providers under the Texas | ||
home living (TxHmL) and home and community-based services (HCS) | ||
waiver programs; and | ||
(2) require managed care organizations to include in | ||
the organizations' provider networks qualified comprehensive | ||
long-term services and supports providers and providers under the | ||
Texas home living (TxHmL) and home and community-based services | ||
(HCS) waiver programs that specialize in services for persons with | ||
intellectual disabilities. | ||
SECTION 22. The following provisions of the Government Code | ||
are repealed: | ||
(1) Sections 534.104(d) and (e); | ||
(2) Section 534.108; | ||
(3) Section 534.110; and | ||
(4) Sections 534.201(c), (d), (e), and (f). | ||
SECTION 23. As soon as practicable after the effective date | ||
of this Act, the executive commissioner of the Health and Human | ||
Services Commission shall adopt rules as necessary to implement the | ||
changes in law made by this Act. | ||
SECTION 24. 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 25. This Act takes effect September 1, 2019. |