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
  86R13606 JG-F
 
  By: Klick H.B. No. 4533
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  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 
  ["Department"   means the Department of Aging and Disability
  Services].
               (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 [and the department] shall [jointly] design and
  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 [and department] shall, in consultation and
  collaboration with the advisory committee, [jointly] implement the
  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 [and the
  department] on the implementation of the acute care services and
  long-term services and supports system redesign under this
  chapter.  Subject to Subsection (b), the executive commissioner
  [and the commissioner of aging and disability services] shall
  [jointly] appoint members of the advisory committee who are
  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 [and the commissioner of aging and disability
  services] shall appoint members of the advisory committee who
  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 [On] January 1, 2029 [2026:
               [(1)  the advisory committee is abolished; and
               [(2)  this section expires].
         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 [2026].
         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 [PROGRAMS TO
  IMPROVE] SERVICE DELIVERY MODELS
         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 ["Provider" means a person with whom
  the commission contracts for the provision of long-term services
  and supports under Medicaid to a specific population based on
  capitation].
               (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 [PROGRAMS] TO TEST MANAGED CARE
  STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION.  The commission,
  in consultation and collaboration with the advisory committee,
  shall [and the department may] develop and implement a pilot
  program [programs] in accordance with this subchapter to test,
  through the STAR+PLUS Medicaid managed care program, the delivery
  of home and community-based services [one or more service delivery
  models involving a managed care strategy based on capitation to
  deliver long-term services and supports under Medicaid] to adults
  [individuals] with an intellectual or developmental disability,
  subject to Section 534.1065.
         Sec. 534.103.  STAKEHOLDER INPUT.  As part of developing and
  implementing the [a] pilot program [under this subchapter], the
  commission, in consultation and collaboration with the advisory
  committee, [department] shall develop a process to receive and
  evaluate:
               (1)  input from statewide stakeholders and
  stakeholders from a health care service [the] region [of the state]
  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 [MANAGED CARE STRATEGY
  PROPOSALS;] PILOT PROGRAM SERVICE DELIVERY PARTICIPANTS
  [PROVIDERS].
         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 [department], in consultation and
  collaboration with the advisory committee, shall develop criteria
  regarding the selection of one or more managed care organizations
  to participate in the pilot program [identify private services
  providers or managed care organizations that are good candidates to
  develop a service delivery model involving a managed care strategy
  based on capitation and to test the model in the provision of
  long-term services and supports under Medicaid to individuals with
  an intellectual or developmental disability through a pilot program
  established under this subchapter].
         [(b)     The department shall solicit managed care strategy
  proposals from the private services providers and managed care
  organizations identified under Subsection (a). In addition, the
  department may accept and approve a managed care strategy proposal
  from any qualified entity that is a private services provider or
  managed care organization if the proposal provides for a
  comprehensive array of long-term services and supports, including
  case management and service coordination.]
         (c)  The [A managed care strategy based on capitation
  developed for implementation through a] pilot program [under this
  subchapter] must be designed to:
               (1)  increase access to home and community-based
  services [long-term services and supports];
               (2)  improve quality of acute care services and home
  and community-based services [long-term services and supports];
               (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 [long-term
  services and supports];
               (5)  promote efficiency and the best use of funding;
               (6)  promote [the placement of an individual in]
  housing stability through housing supports and navigation services
  [that is the least restrictive setting appropriate to the
  individual's needs];
               (7)  promote employment assistance and customized,
  integrated, and competitive employment;
               (8)  provide fair hearing and appeals processes in
  accordance with applicable federal law; [and]
               (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 [For
  each pilot program service provider, the department shall develop
  and implement a pilot program. Under a] pilot program[, the pilot
  program service provider] shall provide long-term services and
  supports under Medicaid to persons with an intellectual or
  developmental disability to test its managed care strategy based on
  capitation.
         (g)  The commission [department], in consultation and
  collaboration with the advisory committee, shall analyze
  information provided by the managed care organizations
  participating in the pilot program [service providers] and any
  information collected by the commission [department] during the
  operation of the pilot program [programs] for purposes of making a
  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 [programs] on the services required to be
  provided under Subsection (f) [:
               [(1)  access to long-term services and supports;
               [(2)     the quality of acute care services and long-term
  services and supports;
               [(3)     meaningful outcomes using person-centered
  planning, individualized budgeting, and self-determination,
  including a person's inclusion in the community;
               [(4)     the integration of service coordination of acute
  care services and long-term services and supports;
               [(5)  the efficiency and use of funding;
               [(6)     the placement of individuals in housing that is
  the least restrictive setting appropriate to an individual's needs;
               [(7)     employment assistance and customized,
  integrated, competitive employment options; and
               [(8)     the number and types of fair hearing and appeals
  processes in accordance with applicable federal law].
         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 [department], in consultation and collaboration with
  the advisory committee, shall identify measurable goals to be
  achieved by the [each] pilot program [implemented under this
  subchapter. The identified goals must:
               [(1)     align with information that will be collected
  under Section 534.108(a); and
               [(2)     be designed to improve the quality of outcomes
  for individuals receiving services through the pilot program].
         (b)  The commission [department], in consultation and
  collaboration with the advisory committee, shall develop [propose]
  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 [and the department] shall implement the [any] pilot
  program [programs established under this subchapter] not later than
  September 1, 2023 [2017].
         (b)  The [A] pilot program [established under this
  subchapter] shall [may] operate for [up to] 24 months. [A pilot
  program may cease operation if the pilot program service provider
  terminates the contract with the commission before the agreed-to
  termination date.]
         (c)  The [A] pilot program [established under this
  subchapter] shall be conducted in one or more health care service
  regions selected by the commission [department].
         Sec. 534.1065.  RECIPIENT PARTICIPATION AND ELIGIBILITY [IN
  PROGRAM VOLUNTARY]. (a) Participation in the [a] pilot program
  [established under this subchapter] by an individual [with an
  intellectual or developmental disability] is voluntary, and the
  decision whether to participate in the pilot [a] program and
  receive [long-term] services under the pilot [and supports from a
  provider through that] program may be made only by the individual or
  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 [COORDINATING
  SERVICES].  (a)  The commission [In providing long-term services
  and supports under Medicaid to individuals with an intellectual or
  developmental disability, a pilot program service provider] shall
  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 [coordinate through the pilot program
  institutional and community-based services available to the
  individuals, including services provided through:
                     [(A)     a facility licensed under Chapter 252,
  Health and Safety Code;
                     [(B)  a Medicaid waiver program; or
                     [(C)     a community-based ICF-IID operated by local
  authorities];
               (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 [collaborate with managed
  care organizations to provide integrated coordination of acute care
  services and long-term services and supports, including discharge
  planning from acute care services to community-based long-term
  services and supports]; and
               (3)  has [have] a process for preventing inappropriate
  institutionalizations of individuals[; and
               [(4)     accept the risk of inappropriate
  institutionalizations of individuals previously residing in
  community settings].
         (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 [cooperation] with the advisory
  committee [department], shall ensure that each individual with an
  intellectual or developmental disability who receives services and
  supports under Medicaid through the [a] pilot program [established
  under this subchapter], or the individual's legally authorized
  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
  [may be an outcome of the plan].
         Sec. 534.111.  CONCLUSION OF PILOT PROGRAM [PROGRAMS];
  EXPIRATION.  On September 1, 2025 [2019]:
               (1)  the [each] pilot program [established under this
  subchapter that is still in operation] must conclude; and
               (2)  this subchapter expires.
         SECTION 13.  Section 534.151(b), Government Code, is amended
  to read as follows:
         (b)  The commission [and the department], in consultation
  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
  [STAR + PLUS] Medicaid managed care program in accordance with this
  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 [the department has] a contract to provide services under
  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
  [the department has] a contract to provide services under:
                           (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 [department] shall contract with and
  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 [STAR + PLUS] Medicaid
  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 [STAR + PLUS] Medicaid managed care
  program, including with making any changes resulting from periodic
  reassessments of the plans;
               (4)  provide to the appropriate managed care
  organization [and the department] information regarding the
  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 [and the department] a description of
  outcomes based on an individual's plan of care.
         (f)  A local intellectual and developmental disability
  authority with which the commission [department] contracts under
  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 [department] may contract with providers
  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 [department] has regulatory and
  oversight authority over the providers with which the commission
  [department] contracts for the delivery of those services.
         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
  [TRANSITION OF RECIPIENTS UNDER TEXAS HOME LIVING (TxHmL) WAIVER
  PROGRAM TO MANAGED CARE PROGRAM].
         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 [This section
  applies to individuals with an intellectual or developmental
  disability who are receiving long-term services and supports under
  the Texas home living (TxHmL) waiver program on the date the
  commission implements the transition described by Subsection (b)].
         (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 [On September 1, 2020,
  the commission shall transition the provision of Medicaid benefits
  to individuals to whom this section applies to the STAR + PLUS
  Medicaid managed care program delivery model or the most
  appropriate integrated capitated managed care program delivery
  model, as determined by the commission based on cost-effectiveness
  and the experience of the STAR + PLUS Medicaid managed care program
  in providing basic attendant and habilitation services and of the
  pilot programs established under Subchapter C, subject to
  Subsection (c)(1)].
         (g)  The comprehensive [commission, in consultation and
  collaboration with the advisory committee, shall analyze the
  outcomes of the transition of the long-term services and supports
  under the Texas home living (TxHmL) Medicaid waiver program to a
  managed care program delivery model. The] analysis conducted under
  Subsection (b) must:
               (1)  include an assessment of the effect of the pilot
  program [transition] on:
                     (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) [(3)]  include recommendations about a system of
  programs and services [for improvements to the transition
  implementation] for consideration by the legislature, including
  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 [OF] ICF-IID
  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[, on the date the
  commission implements the transition described by Subsection (b),]
  are receiving long-term services and supports under:
               (1)  a Medicaid waiver program [other than the Texas
  home living (TxHmL) waiver program]; or
               (2)  an ICF-IID program.
         (b)  After completing the comprehensive analysis under 
  [implementing the transition required by] Section 534.201(g) 
  [534.201], [on September 1, 2021,] the commission shall determine
  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 [transition the
  provision of Medicaid benefits to individuals to whom this section
  applies to the STAR + PLUS Medicaid managed care program delivery
  model or the most appropriate integrated capitated managed care
  program delivery model, as determined by the commission based on
  cost-effectiveness and the experience of the transition of Texas
  home living (TxHmL) waiver program recipients to a managed care
  program delivery model under Section 534.201, subject to
  Subsections (c)(1) and (g)].
         (c)  If the commission determines to [At the time of the]
  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 [program] as provided by Subsection (g);
  or
               (2)  [subject to Subsection (g),] provide all or a
  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 [department] for the reimbursement of ICF-IID
  service providers or a group home provider, as applicable; [and]
               (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 [STAR + PLUS] Medicaid managed care
  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.
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