Bill Text: TX SB2167 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to implementation of the system redesign for the delivery of Medicaid benefits to persons with intellectual or developmental disabilities.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2019-03-21 - Referred to Health & Human Services [SB2167 Detail]

Download: Texas-2019-SB2167-Introduced.html
  86R3638 KFF-F
 
  By: Kolkhorst S.B. No. 2167
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to implementation of the system redesign for the delivery
  of Medicaid benefits to persons with intellectual or developmental
  disabilities.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  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)  On January 1, 2027 [the one-year anniversary of the date
  the commission completes implementation of the transition required
  under Section 534.202]:
               (1)  the advisory committee is abolished; and
               (2)  this section expires.
         SECTION 2.  Chapter 534, Government Code, is amended by
  adding Subchapter C-1 to read as follows:
  SUBCHAPTER C-1. STAR+PLUS HOME AND COMMUNITY-BASED SERVICES PILOT
  PROGRAM 
         Sec. 534.121.  DEFINITION. In this subchapter:
               (1)  "Health care service region" has the meaning
  assigned by Section 533.001.
               (2)  "Pilot program" means the pilot program
  established under Section 534.122.
         Sec. 534.122.  STAR+PLUS HOME AND COMMUNITY-BASED SERVICES
  PILOT PROGRAM IMPLEMENTATION. (a)  Notwithstanding Subchapter C
  and not later than September 1, 2022, the commission shall develop
  and implement a pilot program in accordance with this subchapter to
  test the delivery through the STAR+PLUS Medicaid managed care
  program of home and community-based services to adults with
  intellectual or developmental disabilities who are receiving
  Medicaid benefits:
               (1)  under the STAR+PLUS Medicaid managed care program;
  or
               (2)  as residents of state supported living centers. 
         (b)  The commission shall design the pilot program to meet
  the following goals and objectives:
               (1)  provide access to home and community-based
  services to recipients who are pilot program participants;
               (2)  promote meaningful outcomes by using
  person-centered planning that focuses on the unique needs of
  individuals with intellectual or developmental disabilities and
  their families and caregivers;
               (3)  promote integrated service coordination of acute
  care services and home and community-based services;
               (4)  promote efficiency and the best use of funding;
               (5)  promote housing stability through housing
  supports and navigation services;
               (6)  promote community inclusion and placement through
  enhanced behavioral health supports and crisis intervention
  services;
               (7)  promote employment assistance and customized,
  integrated, and competitive employment; 
               (8)  promote fair hearing and appeals processes
  provided in accordance with applicable federal law; 
               (9)  promote the use of innovative technology and
  benefits, including home monitoring, telemonitoring,
  transportation, and other innovations that support community
  integration; and
               (10)  promote sufficient flexibility to achieve these
  goals.
         (c)  The pilot program must operate:
               (1)  for at least 24 months; and
               (2)  in one or more health care service regions, as
  determined by the commission.
         (d)  The commission shall consult the advisory committee
  regarding the design, implementation, and evaluation of the pilot
  program. 
         Sec. 534.123.  PARTICIPATING MANAGED CARE ORGANIZATIONS.
  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.
         Sec. 534.124.  BENEFITS PROVIDED. The pilot program must
  ensure that managed care organizations participating in the pilot
  program provide: 
               (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; and
                           (iv)  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 determines appropriate.
         Sec. 534.125.  RECIPIENT PARTICIPATION. (a)  The executive
  commissioner shall by rule establish recipient eligibility
  criteria, including financial and functional criteria, for
  participation in the pilot program. In establishing rules under
  this section, the executive commissioner shall ensure the following
  recipients are allowed to enroll in the pilot program: 
               (1)  a recipient receiving services under the STAR+PLUS
  Medicaid managed care program who has an intellectual or
  developmental disability, including a recipient with autism,
  regardless of whether the recipient is:
                     (A)  receiving home and community-based services
  under the STAR+PLUS program; or
                     (B)  on a Medicaid waiver program interest list;
               (2)  a recipient receiving services under the STAR+PLUS
  Medicaid managed care program who has a traumatic brain injury that
  occurred after the recipient reached 21 years of age; and
               (3)  a state supported living center resident who, by
  virtue of participating in the pilot program, is able to transition
  to a community placement.
         (b)  A recipient's participation in the pilot program is
  voluntary.  The decision whether to participate in the program and
  receive long-term services and supports from a provider through the
  program may be made only by the recipient or the recipient's legally
  authorized representative.
         Sec. 534.126.  PERSON-CENTERED PLANNING. The commission
  shall ensure that each recipient who participates in the pilot
  program, or the recipient's legally authorized representative, has
  access to a facilitated, person-centered plan that identifies
  outcomes for the recipient and drives the development of the
  individualized budget.  The consumer direction model, as defined in
  Section 531.051, may be an outcome of the plan.
         Sec. 534.127.  ANNUAL REPORT ON IMPLEMENTATION. Not later
  than September 30 of each year, the commission shall prepare and
  submit a report to the legislature on the implementation of the
  pilot program. The report must include:
               (1)  an assessment of the implementation of the pilot
  program, including appropriate information regarding the provision
  of acute care and home and community-based services to recipients
  participating in the pilot program;
               (2)  recommendations regarding implementation and
  improvements to Medicaid waiver programs, including
  recommendations regarding appropriate statutory changes; and
               (3)  an assessment of the effect of the pilot program on
  the following:
                     (A)  recipient access to home and community-based
  services, including the additional services included in the pilot
  program in accordance with Sections 534.124(2) and (3);
                     (B)  the quality of services provided under the
  pilot program;
                     (C)  meaningful outcomes for recipients using
  person-centered planning, individualized budgeting, and
  self-determination, including outcomes related to community
  inclusion;
                     (D)  the integration of service coordination of
  acute care services and home and community-based services;
                     (E)  the efficiency and use of funding and impact
  for future transitions of Medicaid waiver programs; 
                     (F)  the placement and retention of recipients in
  housing that is the least restrictive setting appropriate to the
  recipients' needs;
                     (G)  employment assistance and customized,
  integrated, competitive employment options; and 
                     (H)  the number and types of fair hearings and
  appeals sought by participants in the pilot program.
         Sec. 534.128.  This subchapter expires September 30, 2025.
         SECTION 3.  Section 534.201(b), Government Code, is amended
  to read as follows:
         (b)  On September 1, 2024 [2020], the commission shall
  transition the provision of Medicaid benefits to individuals to
  whom this section applies to the STAR+PLUS [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 [STAR + PLUS] Medicaid managed care
  program in providing basic attendant and habilitation services and
  of the pilot programs established under Subchapters [Subchapter] C
  and C-1, subject to Subsection (c)(1).
         SECTION 4.  Section 534.202(b), Government Code, is amended
  to read as follows:
         (b)  After implementing the transition required by Section
  534.201, on September 1, 2025 [2021], the commission shall
  transition the provision of Medicaid benefits to individuals to
  whom this section applies to the STAR+PLUS [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).
         SECTION 5.  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.
         SECTION 6.  Notwithstanding Section 534.127, Government
  Code, as added by this Act, the Health and Human Services Commission
  shall submit the initial report required by that section not later
  than September 30, 2020.
         SECTION 7.  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 8.  This Act takes effect September 1, 2019.
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