Bill Text: TX SB1101 | 2019-2020 | 86th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the consolidation of ombudsman programs administered by the Health and Human Services Commission.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2019-05-17 - Committee report sent to Calendars [SB1101 Detail]
Download: Texas-2019-SB1101-Introduced.html
Bill Title: Relating to the consolidation of ombudsman programs administered by the Health and Human Services Commission.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2019-05-17 - Committee report sent to Calendars [SB1101 Detail]
Download: Texas-2019-SB1101-Introduced.html
86R11449 SCL-F | ||
By: Kolkhorst | S.B. No. 1101 |
|
||
|
||
relating to the consolidation of ombudsman programs administered by | ||
the Health and Human Services Commission. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. The heading to Subchapter Y, Chapter 531, | ||
Government Code, is amended to read as follows: | ||
SUBCHAPTER Y. COMMISSION OMBUDSMAN PROGRAMS [ |
||
|
||
SECTION 2. Section 531.991, Government Code, is amended by | ||
amending Subdivision (2) and adding Subdivision (3) to read as | ||
follows: | ||
(2) "Ombudsman" means the individual appointed as the | ||
ombudsman for an ombudsman program [ |
||
|
||
(3) "Ombudsman program" means an ombudsman program | ||
administered by the commission under this subchapter. | ||
SECTION 3. Subchapter Y, Chapter 531, Government Code, is | ||
amended by adding Section 531.9912 to read as follows: | ||
Sec. 531.9912. ESTABLISHMENT OF OMBUDSMAN PROGRAMS. The | ||
executive commissioner shall establish the following ombudsman | ||
programs: | ||
(1) the health and human services office of the | ||
ombudsman in accordance with Section 531.9915; | ||
(2) the ombudsman for children and youth in foster | ||
care in accordance with Section 531.9931; | ||
(3) the ombudsman for managed care assistance in | ||
accordance with Section 531.9932; and | ||
(4) the ombudsman for behavioral health access to care | ||
in accordance with Section 531.9933. | ||
SECTION 4. Section 531.0171, Government Code, is | ||
transferred to Subchapter Y, Chapter 531, Government Code, and | ||
redesignated as Section 531.9915, Government Code, to read as | ||
follows: | ||
Sec. 531.9915 [ |
||
executive commissioner shall establish the commission's office of | ||
the ombudsman with authority and responsibility over the health and | ||
human services system in performing the following functions: | ||
(1) providing dispute resolution services for the | ||
health and human services system; | ||
(2) performing consumer protection and advocacy | ||
functions related to health and human services, including assisting | ||
a consumer or other interested person with: | ||
(A) raising a matter within the health and human | ||
services system that the person feels is being ignored; and | ||
(B) obtaining information regarding a filed | ||
complaint; and | ||
(3) collecting inquiry and complaint data related to | ||
the health and human services system. | ||
(b) The office of the ombudsman does not have the authority | ||
to provide a separate process for resolving complaints or appeals. | ||
(c) The executive commissioner shall develop a standard | ||
process for tracking and reporting received inquiries and | ||
complaints within the health and human services system. The | ||
process must provide for the centralized tracking of inquiries and | ||
complaints submitted to field, regional, or other local health and | ||
human services system offices. | ||
(d) Using the process developed under Subsection (c), the | ||
office of the ombudsman shall collect inquiry and complaint data | ||
from all offices, agencies, divisions, and other entities within | ||
the health and human services system. To assist with the | ||
collection of data under this subsection, the office may access any | ||
system or process for recording inquiries and complaints used or | ||
maintained within the health and human services system. | ||
SECTION 5. Sections 531.992, 531.9921, and 531.993, | ||
Government Code, are amended to read as follows: | ||
Sec. 531.992. APPOINTMENT OF OMBUDSMAN [ |
||
|
||
[ |
||
[ |
||
will of the executive commissioner [ |
||
(b) The ombudsman programs are [ |
||
attached to the office of the ombudsman for the commission. | ||
(c) Subject to the appropriation of money for those purposes | ||
[ |
||
ombudsman in performing the ombudsman's duties under this | ||
subchapter. | ||
(d) An [ |
||
the commission [ |
||
produced and distributed by the ombudsman. | ||
Sec. 531.9921. CONFLICT OF INTEREST. A person may not serve | ||
as ombudsman in an ombudsman program if the person or the person's | ||
spouse: | ||
(1) is employed by or participates in the management | ||
of a business entity or other organization receiving funds from the | ||
commission [ |
||
(2) owns or controls, directly or indirectly, any | ||
interest in a business entity or other organization receiving funds | ||
from the commission [ |
||
(3) is required to register as a lobbyist under | ||
Chapter 305 because of the person's activities for compensation on | ||
behalf of a profession related to the operation of the commission | ||
[ |
||
Sec. 531.993. DUTIES OF OMBUDSMAN. (a) An [ |
||
serves as a neutral party in assisting: | ||
(1) children and youth in the conservatorship of the | ||
department with complaints regarding issues within the authority of | ||
the commission or department, as applicable [ |
||
|
||
(2) persons with a complaint against the commission or | ||
department regarding case-specific activities of the programs of | ||
the commission or department, including adult protective services, | ||
child protective services, child-care licensing, and statewide | ||
intake. | ||
(b) An [ |
||
(1) develop and implement statewide procedures to: | ||
(A) receive complaints from: | ||
(i) children and youth in the | ||
conservatorship of the department; and | ||
(ii) other persons with a complaint against | ||
the commission or department; | ||
(B) review complaints filed with the ombudsman | ||
and take appropriate action, including: | ||
(i) conducting an investigation into | ||
individual complaints that allege violations of commission or | ||
department [ |
||
(ii) referring to commission or department | ||
[ |
||
identified in complaints; | ||
(C) provide any necessary assistance to: | ||
(i) children and youth in the | ||
conservatorship of the department in making complaints and | ||
reporting allegations of abuse or neglect to the department; and | ||
(ii) any other person in making complaints | ||
to the commission; | ||
(D) maintain the confidentiality of: | ||
(i) the ombudsman's communications and | ||
records; | ||
(ii) records of another person that have | ||
been provided to the ombudsman; and | ||
(iii) communications of another person with | ||
the ombudsman; and | ||
(E) ensure that the commission, department, and | ||
any person who files a complaint with the commission or department, | ||
including [ |
||
department who files a complaint with the ombudsman, are informed | ||
of the results of the ombudsman's investigation of the complaint, | ||
including whether the ombudsman was able to substantiate the | ||
person's, child's, or youth's complaint; | ||
(2) collaborate with the commission or department, as | ||
applicable, to develop and implement an annual outreach plan to | ||
promote awareness of the ombudsman among the public, children and | ||
youth in the conservatorship of the department, family members and | ||
caretakers of those children, and facilities licensed by the | ||
commission [ |
||
(A) how the office may be contacted; | ||
(B) the purpose of the office; and | ||
(C) the services the office provides; | ||
(3) issue and file with the commission or department, | ||
as applicable, [ |
||
|
||
regarding a complaint and any recommended corrective actions to be | ||
taken as a result of the complaint; | ||
(4) establish a secure form of communication with any | ||
individual who files a complaint with the ombudsman; | ||
(5) collaborate with the commission or department, as | ||
applicable, to identify consequences for any retaliatory action | ||
related to a complaint filed with the ombudsman, in accordance with | ||
Section 531.997 [ |
||
(6) monitor and evaluate the commission's or | ||
department's corrective actions taken in response to a | ||
recommendation by the ombudsman. | ||
(c) An [ |
||
described by Subsection (b)(3) must include a determination of | ||
whether there was wrongdoing or negligence by the commission, | ||
department, or an agent of the commission or department or whether | ||
the complaint was frivolous and without merit. If the ombudsman | ||
determines there was wrongdoing or negligence, the ombudsman shall | ||
recommend corrective actions to be taken by the commission or | ||
department. | ||
(c-1) The department and the commission's child care | ||
licensing division shall provide written notice to the ombudsman on | ||
whether the department or child care licensing division adopted or | ||
rejected the ombudsman's recommended corrective action. If the | ||
department or child care licensing division rejects a recommended | ||
corrective action, the department or division shall include in the | ||
notice the reason for the rejection. | ||
(d) An [ |
||
related to a complaint filed with the ombudsman's office. | ||
SECTION 6. The heading to Section 531.9931, Government | ||
Code, is amended to read as follows: | ||
Sec. 531.9931. [ |
||
YOUTH IN FOSTER CARE. | ||
SECTION 7. Section 531.0213, Government Code, is | ||
transferred to Subchapter Y, Chapter 531, Government Code, | ||
redesignated as Section 531.9932, Government Code, and amended to | ||
read as follows: | ||
Sec. 531.9932 [ |
||
ASSISTANCE [ |
||
commission shall establish an ombudsman program to provide support | ||
and information services to a person enrolled in or applying for | ||
Medicaid coverage who experiences barriers to receiving health care | ||
services. | ||
(b) The ombudsman appointed under this section [ |
||
shall give emphasis to assisting a person with an urgent or | ||
immediate medical or support need. | ||
(b-1) The commission shall provide support and information | ||
services required by this section through a network of entities | ||
coordinated by the commission's office of the ombudsman [ |
||
|
||
|
||
(1) the commission's office of the ombudsman or other | ||
division of the commission designated by the executive commissioner | ||
to coordinate the network; | ||
(2) the office of the state long-term care ombudsman | ||
required under Subchapter F, Chapter 101A, Human Resources Code; | ||
(3) the division within the commission responsible for | ||
oversight of Medicaid managed care contracts; | ||
(4) area agencies on aging; | ||
(5) 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; and | ||
(6) any other entity the executive commissioner | ||
determines appropriate, including nonprofit organizations with | ||
which the commission contracts under Subsection (c). | ||
(c) The ombudsman [ |
||
information services by requesting the commission to contract | ||
[ |
||
providing health care, health insurance, or health benefits. | ||
(d) As a part of the support and information services | ||
required by this section, the ombudsman [ |
||
(1) operate a statewide toll-free assistance | ||
telephone number that includes relay services for persons with | ||
speech or hearing disabilities and assistance for persons who speak | ||
Spanish; | ||
(2) intervene promptly with the state Medicaid office, | ||
managed care organizations and providers, and any other appropriate | ||
entity on behalf of a person who has an urgent need for medical | ||
services; | ||
(3) assist a person who is experiencing barriers in | ||
the Medicaid application and enrollment process and refer the | ||
person for further assistance if appropriate; | ||
(4) educate persons so that they: | ||
(A) understand the concept of managed care; | ||
(B) understand their rights under Medicaid, | ||
including grievance and appeal procedures; and | ||
(C) are able to advocate for themselves; | ||
(5) collect and maintain statistical information on a | ||
regional basis regarding calls received by the assistance lines and | ||
publish quarterly reports that: | ||
(A) list the number of calls received by region; | ||
(B) identify trends in delivery and access | ||
problems; | ||
(C) identify recurring barriers in the Medicaid | ||
system; and | ||
(D) indicate other problems identified with | ||
Medicaid managed care; | ||
(6) assist the state Medicaid office and managed care | ||
organizations and providers in identifying and correcting | ||
problems, including site visits to affected regions if necessary; | ||
(7) meet the needs of all current and future Medicaid | ||
managed care recipients, including children receiving dental | ||
benefits and other recipients receiving benefits, under the: | ||
(A) STAR Medicaid managed care program; | ||
(B) STAR + PLUS Medicaid managed care program, | ||
including the Texas Dual Eligibles Integrated Care Demonstration | ||
Project provided under that program; | ||
(C) STAR Kids managed care program established | ||
under Section 533.00253; and | ||
(D) STAR Health program; | ||
(8) incorporate support services for children | ||
enrolled in the child health plan established under Chapter 62, | ||
Health and Safety Code; and | ||
(9) ensure that staff providing support and | ||
information services receives sufficient training, including | ||
training in the Medicare program for the purpose of assisting | ||
recipients who are dually eligible for Medicare and Medicaid, and | ||
has sufficient authority to resolve barriers experienced by | ||
recipients to health care and long-term services and supports. | ||
(e) The commission's office of the ombudsman[ |
||
|
||
|
||
|
||
sufficiently independent from other aspects of Medicaid managed | ||
care to represent the best interests of recipients in problem | ||
resolution. | ||
SECTION 8. Section 531.02251, Government Code, is | ||
transferred to Subchapter Y, Chapter 531, Government Code, and | ||
redesignated as Section 531.9933, Government Code, to read as | ||
follows: | ||
Sec. 531.9933 [ |
||
ACCESS TO CARE. (a) In this section, "ombudsman" means the | ||
individual designated as the ombudsman for behavioral health access | ||
to care. | ||
(b) The executive commissioner shall designate an ombudsman | ||
for behavioral health access to care. | ||
(c) The ombudsman is administratively attached to the | ||
office of the ombudsman for the commission. | ||
(d) The commission may use an alternate title for the | ||
ombudsman in consumer-facing materials if the commission | ||
determines that an alternate title would be beneficial to consumer | ||
understanding or access. | ||
(e) The ombudsman serves as a neutral party to help | ||
consumers, including consumers who are uninsured or have public or | ||
private health benefit coverage, and behavioral health care | ||
providers navigate and resolve issues related to consumer access to | ||
behavioral health care, including care for mental health conditions | ||
and substance use disorders. | ||
(f) The ombudsman shall: | ||
(1) interact with consumers and behavioral health care | ||
providers with concerns or complaints to help the consumers and | ||
providers resolve behavioral health care access issues; | ||
(2) identify, track, and help report potential | ||
violations of state or federal rules, regulations, or statutes | ||
concerning the availability of, and terms and conditions of, | ||
benefits for mental health conditions or substance use disorders, | ||
including potential violations related to quantitative and | ||
nonquantitative treatment limitations; | ||
(3) report concerns, complaints, and potential | ||
violations described by Subdivision (2) to the appropriate | ||
regulatory or oversight agency; | ||
(4) receive and report concerns and complaints | ||
relating to inappropriate care or mental health commitment; | ||
(5) provide appropriate information to help consumers | ||
obtain behavioral health care; | ||
(6) develop appropriate points of contact for | ||
referrals to other state and federal agencies; and | ||
(7) provide appropriate information to help consumers | ||
or providers file appeals or complaints with the appropriate | ||
entities, including insurers and other state and federal agencies. | ||
(g) The ombudsman shall participate in the mental health | ||
condition and substance use disorder parity work group established | ||
under Section 531.02252 and provide summary reports of concerns, | ||
complaints, and potential violations described by Subsection | ||
(f)(2) to the work group. This subsection expires September 1, | ||
2021. | ||
(h) The Texas Department of Insurance shall appoint a | ||
liaison to the ombudsman to receive reports of concerns, | ||
complaints, and potential violations described by Subsection | ||
(f)(2) from the ombudsman, consumers, or behavioral health care | ||
providers. | ||
SECTION 9. Sections 531.994 and 531.9941, Government Code, | ||
are amended to read as follows: | ||
Sec. 531.994. INVESTIGATION OF UNREPORTED COMPLAINTS. If, | ||
during the investigation of a complaint, an [ |
||
discovers unreported violations of the commission's or department's | ||
[ |
||
ombudsman shall open a new investigation for each unreported | ||
violation. | ||
Sec. 531.9941. DISPUTES REGARDING FOSTER CHILDREN. (a) A | ||
child-placing agency responsible for a foster child may refer a | ||
dispute regarding the child's placement or the permanency plan for | ||
the child to the ombudsman for children and youth in foster care by | ||
filing a complaint with the ombudsman. | ||
(b) The complaint filed with the ombudsman for children and | ||
youth in foster care must include a clear explanation of the dispute | ||
and the requested remedy. | ||
(c) The ombudsman for children and youth in foster care | ||
shall notify the court with jurisdiction over the child's case of | ||
any investigation of a complaint filed under this subchapter | ||
related to foster care. | ||
SECTION 10. Sections 531.995, 531.996, 531.997, and | ||
531.998, Government Code, are amended to read as follows: | ||
Sec. 531.995. ACCESS TO INFORMATION. The commission or | ||
department, as applicable, [ |
||
|
||
or department's [ |
||
ombudsman is reviewing or investigating. | ||
Sec. 531.996. COMMUNICATION AND CONFIDENTIALITY. (a) A | ||
person may communicate with an [ |
||
complaint by telephone, by mail, by electronic mail, or by any other | ||
means the ombudsman determines to be feasible, secure, and | ||
accessible to children and youth and other persons. | ||
(b) A communication with an [ |
||
during an investigation or review of a complaint and remains | ||
confidential after the complaint is resolved. | ||
(c) The records of an [ |
||
must be maintained in a manner that preserves the confidentiality | ||
of the records. | ||
(d) The disclosure of confidential information to an [ |
||
ombudsman under this section or Section 531.995 does not constitute | ||
a waiver of confidentiality. Any information disclosed to the | ||
ombudsman under this section or Section 531.995 remains | ||
confidential and privileged following disclosure. | ||
(e) An [ |
||
with the commission or department [ |
||
|
||
the ombudsman by the commission or department [ |
||
(f) An [ |
||
investigation of a complaint public after the complaint is | ||
resolved. A report may not include information that identifies an | ||
individual complainant, client, parent, or employee or any other | ||
person involved in the complaint. | ||
Sec. 531.997. RETALIATION PROHIBITED. The commission or | ||
department [ |
||
retaliate against a commission or department employee, a child or | ||
youth in the conservatorship of the department, or any other person | ||
who in good faith makes a complaint to an [ |
||
any person who cooperates with the ombudsman in an investigation. | ||
Sec. 531.998. REPORT. (a) Each [ |
||
prepare an annual report that contains: | ||
(1) a description of the ombudsman's work; | ||
(2) any change made by the commission or department | ||
[ |
||
substantiated complaint; | ||
(3) a description of any trends in the nature of | ||
complaints received by the ombudsman, any recommendations related | ||
to addressing those trends, and an evaluation of the feasibility of | ||
the ombudsman's recommendations; | ||
(4) a glossary of terms used in the report; | ||
(5) a description of the methods used to promote | ||
awareness of the ombudsman under Section 531.993(b) and the | ||
ombudsman's promotion plan for the next year; and | ||
(6) any public feedback received by the ombudsman | ||
relating to the ombudsman's previous annual reports. | ||
(b) Each [ |
||
lieutenant governor, each standing committee of the legislature | ||
with jurisdiction over matters involving the commission or | ||
department, as applicable, each member of the legislature, the | ||
executive commissioner, and the commissioner of the department not | ||
later than December 1 of each year. On receipt of the report, the | ||
department and the commission shall make the report publicly | ||
available on the department's and the commission's Internet | ||
websites, as applicable. | ||
SECTION 11. 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 12. This Act takes effect immediately if it | ||
receives a vote of two-thirds of all the members elected to each | ||
house, as provided by Section 39, Article III, Texas Constitution. | ||
If this Act does not receive the vote necessary for immediate | ||
effect, this Act takes effect September 1, 2019. |