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A BILL TO BE ENTITLED
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AN ACT
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relating to implementation of the system redesign for the delivery |
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of Medicaid benefits to persons with intellectual or developmental |
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disabilities. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 534.053(g), Government Code, as amended |
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by Chapters 837 (S.B. 200), 946 (S.B. 277), and 1117 (H.B. 3523), |
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Acts of the 84th Legislature, Regular Session, 2015, is reenacted |
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and amended to read as follows: |
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(g) On January 1, 2027 [the one-year anniversary of the date
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the commission completes implementation of the transition required
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under Section 534.202]: |
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(1) the advisory committee is abolished; and |
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(2) this section expires. |
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SECTION 2. Chapter 534, Government Code, is amended by |
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adding Subchapter C-1 to read as follows: |
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SUBCHAPTER C-1. STAR+PLUS HOME AND COMMUNITY-BASED SERVICES PILOT |
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PROGRAM |
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Sec. 534.121. DEFINITION. In this subchapter: |
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(1) "Health care service region" has the meaning |
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assigned by Section 533.001. |
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(2) "Pilot program" means the pilot program |
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established under Section 534.122. |
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Sec. 534.122. STAR+PLUS HOME AND COMMUNITY-BASED SERVICES |
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PILOT PROGRAM IMPLEMENTATION. (a) Notwithstanding Subchapter C |
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and not later than September 1, 2022, the commission shall develop |
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and implement a pilot program in accordance with this subchapter to |
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test the delivery through the STAR+PLUS Medicaid managed care |
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program of home and community-based services to adults with |
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intellectual or developmental disabilities who are receiving |
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Medicaid benefits: |
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(1) under the STAR+PLUS Medicaid managed care program; |
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or |
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(2) as residents of state supported living centers. |
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(b) The commission shall design the pilot program to meet |
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the following goals and objectives: |
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(1) provide access to home and community-based |
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services to recipients who are pilot program participants; |
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(2) promote meaningful outcomes by using |
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person-centered planning that focuses on the unique needs of |
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individuals with intellectual or developmental disabilities and |
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their families and caregivers; |
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(3) promote integrated service coordination of acute |
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care services and home and community-based services; |
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(4) promote efficiency and the best use of funding; |
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(5) promote housing stability through housing |
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supports and navigation services; |
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(6) promote community inclusion and placement through |
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enhanced behavioral health supports and crisis intervention |
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services; |
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(7) promote employment assistance and customized, |
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integrated, and competitive employment; |
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(8) promote fair hearing and appeals processes |
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provided in accordance with applicable federal law; |
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(9) promote the use of innovative technology and |
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benefits, including home monitoring, telemonitoring, |
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transportation, and other innovations that support community |
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integration; and |
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(10) promote sufficient flexibility to achieve these |
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goals. |
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(c) The pilot program must operate: |
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(1) for at least 24 months; and |
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(2) in one or more health care service regions, as |
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determined by the commission. |
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(d) The commission shall consult the advisory committee |
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regarding the design, implementation, and evaluation of the pilot |
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program. |
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Sec. 534.123. PARTICIPATING MANAGED CARE ORGANIZATIONS. |
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The commission shall select and contract with one or more managed |
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care organizations participating in the STAR+PLUS Medicaid managed |
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care program to participate in the pilot program. |
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Sec. 534.124. BENEFITS PROVIDED. The pilot program must |
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ensure that managed care organizations participating in the pilot |
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program provide: |
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(1) all Medicaid state plan benefits available under |
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the STAR+PLUS program, including: |
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(A) acute care services, including physical |
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health, behavioral health, specialty care, inpatient hospital, and |
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outpatient pharmacy services; and |
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(B) long-term services and supports, including: |
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(i) Community First Choice services; |
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(ii) personal assistance services; |
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(iii) day activity health services; and |
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(iv) home and community-based services, |
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including assisted living, personal assistance services, |
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employment assistance, supported employment, adult foster care, |
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dental care, nursing care, respite care, home-delivered meals, and |
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therapy services; |
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(2) the following additional home and community-based |
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services: |
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(A) enhanced behavioral health services; |
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(B) behavioral supports; |
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(C) day habilitation; |
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(D) housing supports; |
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(E) community support transportation; and |
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(F) crisis intervention services; and |
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(3) other home and community-based services the |
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commission determines appropriate. |
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Sec. 534.125. RECIPIENT PARTICIPATION. (a) The executive |
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commissioner shall by rule establish recipient eligibility |
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criteria, including financial and functional criteria, for |
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participation in the pilot program. In establishing rules under |
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this section, the executive commissioner shall ensure the following |
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recipients are allowed to enroll in the pilot program: |
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(1) a recipient receiving services under the STAR+PLUS |
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Medicaid managed care program who has an intellectual or |
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developmental disability, including a recipient with autism, |
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regardless of whether the recipient is: |
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(A) receiving home and community-based services |
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under the STAR+PLUS program; or |
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(B) on a Medicaid waiver program interest list; |
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(2) a recipient receiving services under the STAR+PLUS |
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Medicaid managed care program who has a traumatic brain injury that |
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occurred after the recipient reached 21 years of age; and |
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(3) a state supported living center resident who, by |
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virtue of participating in the pilot program, is able to transition |
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to a community placement. |
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(b) A recipient's participation in the pilot program is |
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voluntary. The decision whether to participate in the program and |
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receive long-term services and supports from a provider through the |
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program may be made only by the recipient or the recipient's legally |
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authorized representative. |
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Sec. 534.126. PERSON-CENTERED PLANNING. The commission |
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shall ensure that each recipient who participates in the pilot |
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program, or the recipient's legally authorized representative, has |
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access to a facilitated, person-centered plan that identifies |
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outcomes for the recipient and drives the development of the |
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individualized budget. The consumer direction model, as defined in |
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Section 531.051, may be an outcome of the plan. |
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Sec. 534.127. ANNUAL REPORT ON IMPLEMENTATION. Not later |
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than September 30 of each year, the commission shall prepare and |
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submit a report to the legislature on the implementation of the |
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pilot program. The report must include: |
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(1) an assessment of the implementation of the pilot |
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program, including appropriate information regarding the provision |
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of acute care and home and community-based services to recipients |
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participating in the pilot program; |
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(2) recommendations regarding implementation and |
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improvements to Medicaid waiver programs, including |
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recommendations regarding appropriate statutory changes; and |
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(3) an assessment of the effect of the pilot program on |
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the following: |
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(A) recipient access to home and community-based |
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services, including the additional services included in the pilot |
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program in accordance with Sections 534.124(2) and (3); |
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(B) the quality of services provided under the |
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pilot program; |
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(C) meaningful outcomes for recipients using |
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person-centered planning, individualized budgeting, and |
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self-determination, including outcomes related to community |
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inclusion; |
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(D) the integration of service coordination of |
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acute care services and home and community-based services; |
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(E) the efficiency and use of funding and impact |
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for future transitions of Medicaid waiver programs; |
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(F) the placement and retention of recipients in |
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housing that is the least restrictive setting appropriate to the |
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recipients' needs; |
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(G) employment assistance and customized, |
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integrated, competitive employment options; and |
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(H) the number and types of fair hearings and |
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appeals sought by participants in the pilot program. |
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Sec. 534.128. This subchapter expires September 30, 2025. |
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SECTION 3. Section 534.201(b), Government Code, is amended |
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to read as follows: |
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(b) On September 1, 2024 [2020], the commission shall |
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transition the provision of Medicaid benefits to individuals to |
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whom this section applies to the STAR+PLUS [STAR + PLUS] Medicaid |
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managed care program delivery model or the most appropriate |
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integrated capitated managed care program delivery model, as |
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determined by the commission based on cost-effectiveness and the |
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experience of the STAR+PLUS [STAR + PLUS] Medicaid managed care |
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program in providing basic attendant and habilitation services and |
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of the pilot programs established under Subchapters [Subchapter] C |
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and C-1, subject to Subsection (c)(1). |
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SECTION 4. Section 534.202(b), Government Code, is amended |
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to read as follows: |
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(b) After implementing the transition required by Section |
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534.201, on September 1, 2025 [2021], the commission shall |
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transition the provision of Medicaid benefits to individuals to |
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whom this section applies to the STAR+PLUS [STAR + PLUS] Medicaid |
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managed care program delivery model or the most appropriate |
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integrated capitated managed care program delivery model, as |
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determined by the commission based on cost-effectiveness and the |
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experience of the transition of Texas home living (TxHmL) waiver |
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program recipients to a managed care program delivery model under |
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Section 534.201, subject to Subsections (c)(1) and (g). |
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SECTION 5. Section 534.203, Government Code, is amended to |
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read as follows: |
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Sec. 534.203. RESPONSIBILITIES OF COMMISSION UNDER |
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SUBCHAPTER. In administering this subchapter, the commission shall |
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ensure: |
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(1) that the commission is responsible for setting the |
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minimum reimbursement rate paid to a provider of ICF-IID services |
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or a group home provider under the integrated managed care system, |
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including the staff rate enhancement paid to a provider of ICF-IID |
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services or a group home provider; |
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(2) that an ICF-IID service provider or a group home |
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provider is paid not later than the 10th day after the date the |
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provider submits a clean claim in accordance with the criteria used |
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by the commission [department] for the reimbursement of ICF-IID |
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service providers or a group home provider, as applicable; and |
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(3) the establishment of an electronic portal through |
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which a provider of ICF-IID services or a group home provider |
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participating in the STAR+PLUS [STAR + PLUS] Medicaid managed care |
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program delivery model or the most appropriate integrated capitated |
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managed care program delivery model, as appropriate, may submit |
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long-term services and supports claims to any participating managed |
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care organization. |
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SECTION 6. Notwithstanding Section 534.127, Government |
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Code, as added by this Act, the Health and Human Services Commission |
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shall submit the initial report required by that section not later |
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than September 30, 2020. |
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SECTION 7. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 8. This Act takes effect September 1, 2019. |