81R388 CLG-D
By: Guillen H.B. No. 1398
A BILL TO BE ENTITLED
AN ACT
relating to a pilot project to establish a comprehensive single
point of entry for long-term services and supports provided to the
aged and physically disabled individuals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0525 to read as follows:
Sec. 531.0525. PILOT PROJECT TO ESTABLISH COMPREHENSIVE
SINGLE POINT OF ENTRY FOR LONG-TERM SERVICES AND SUPPORTS. (a) In
this section:
(1) "Aging and disability resource center" means a
center established under the Aging and Disability Resource Center
grant program jointly sponsored by the federal Administration on
Aging and the Centers for Medicare and Medicaid Services.
(2) "Department of Aging and Disability Services staff
members" includes the department's access and intake staff members
and the department's community care for the aged and disabled staff
members.
(3) "Expedited service authorization" means
authorization of services within seven calendar days based on a
screening of applicants and tentative eligibility for receipt of
services and initiation of those services as soon as possible.
(4) "Long-term services and supports" means long-term
assistance or care provided to the aged or physically disabled
individuals through the Medicaid program or other programs. The
term includes assistance or care provided through the following
programs:
(A) the primary home care program;
(B) the community attendant services program;
(C) the community-based alternatives program;
(D) the day activity and health services program;
(E) the promoting independence program;
(F) a program funded through the Older Americans
Act of 1965 (42 U.S.C. Section 3001 et seq.);
(G) a community care program funded through Title
XX of the federal Social Security Act (42 U.S.C. Section 301 et
seq.);
(H) the program of all-inclusive care for the
elderly (PACE), if the program is available in the area served by
the pilot project;
(I) the in-home and family support program; and
(J) a nursing facility program.
(5) "Long-term services and supports staff" means:
(A) one or more of the commission's Medicaid
eligibility determination staff members;
(B) one or more Department of Aging and
Disability Services staff members; and
(C) one or more local area agency on aging staff
members.
(6) "Physically colocated staff members" means
long-term services and supports staff members who are located in
the same physical office.
(7) "Pilot project site" means a location in an area
served by the pilot project established under this section where
physically colocated staff members work collaboratively to
authorize and initiate long-term services and supports. The term
does not include a location where staff members work together
solely by means of virtual communication, such as e-mail or the
Internet, or by telephone.
(8) "Tentative eligibility," with respect to receipt
of services, means a process by which eligibility for services is
provisionally determined based on a standard screening tool that
assesses both functional and financial program eligibility for
receipt of services.
(b) The commission shall develop and implement in not more
than three geographic areas of this state a pilot project to
establish a comprehensive single point of entry system for
long-term services and supports in which long-term services and
supports staff members located in the same physical office work in
collaboration to provide all necessary services in connection with
long-term services and supports from the intake process to the
start of service delivery. The pilot project must require that, at
a minimum, physically colocated staff members work collaboratively
to:
(1) screen the aged and physically disabled
individuals requesting long-term services and supports;
(2) establish tentative eligibility for long-term
services and supports;
(3) support and provide expedited service
authorization for the aged and physically disabled individuals
requesting long-term services and supports for which there are no
waiting lists; and
(4) make final determinations of financial
eligibility for long-term services and supports after a period of
tentative eligibility for receipt of those services and supports.
(c) In developing and implementing the pilot project, the
commission shall ensure that:
(1) each pilot project site serves as a comprehensive
single point of entry for the aged and physically disabled
individuals to access long-term services and supports in the site's
service area;
(2) each pilot project site is designed and operated
in accordance with best practices adopted by the executive
commissioner after the commission reviews best practices for
similar initiatives in other states and professional policy-based
research describing best practices for successful initiatives;
(3) the physically colocated staff members at each
pilot project site include:
(A) one or more full-time commission staff
members who determine eligibility for the Medicaid program and who:
(i) have full access to the Texas
Integrated Eligibility Redesign System (TIERS) or the System of
Application, Verification, Eligibility, Referral, and Reporting
(SAVERR);
(ii) have previously made Medicaid
long-term care eligibility determinations; and
(iii) are dedicated primarily to making
eligibility determinations for incoming clients at the site;
(B) sufficient Department of Aging and
Disability Services staff members to carry out the screening and
expedited service authorization functions at the site;
(C) sufficient area agency on aging staff members
to:
(i) assist with the performance of
screening functions and service coordination for services funded
under the Older Americans Act of 1965 (42 U.S.C. Section 3001 et
seq.), such as meals programs; and
(ii) identify other locally funded and
supported services that will enable the aged or physically disabled
individuals to continue to reside in the community to the extent
reasonable; and
(D) any available staff members from local
service agencies; and
(4) the physically colocated staff members of a pilot
project site:
(A) use a standardized screening tool that:
(i) assesses both functional and financial
program eligibility; and
(ii) provides sufficient information to
make a tentative eligibility determination for receipt of services;
(B) process requests for long-term services and
supports in person or by telephone or through the Internet;
(C) perform all screening and assessment,
eligibility determination, and service authorization functions
necessary to promptly initiate appropriate service delivery;
(D) closely coordinate with local hospital
discharge planners and staff members of extended rehabilitation
units of local hospitals and nursing homes;
(E) give first priority to individuals who
urgently need services; and
(F) inform individuals about community-based
services available in the area served by the pilot project.
(d) An area in which the pilot project will be implemented
may consist of a single county or a multicounty region, as
determined by the commission. At least one of the areas must have a
pilot project site located within an aging and disability resource
center. If the commission finds that there is no aging and
disability resource center that is willing or able to accomodate a
pilot project site on the date the pilot project is to be
implemented, the pilot project site may be located at a local
Department of Aging and Disability Services office, an area agency
on aging office, or another appropriate location.
(e) Not later than January 31, 2011, the commission shall
submit a report concerning the pilot project to the presiding
officers of the standing committees of the senate and house of
representatives having primary jurisdiction over health and human
services. The report must:
(1) be prepared by a person not associated with the
pilot project or the commission;
(2) contain, for each area of this state in which the
pilot project is being implemented, an evaluation of the operation
of the pilot project in that area;
(3) contain an evaluation of the pilot project's
benefits for individuals who received services;
(4) contain a calculation of the costs and cost
savings that can be attributed to implementation of the pilot
project;
(5) include a recommendation regarding adopting
improved policies and procedures concerning long-term services and
supports with statewide applicability, as determined from
information obtained in operating the pilot project;
(6) include a recommendation regarding the
feasibility of expanding the pilot project to other areas of this
state or statewide; and
(7) contain the perspectives of service providers of
programs listed in Subsection (a)(4) who are operating in the area
served by a pilot project site.
(f) This section expires September 1, 2013.
SECTION 2. Not later than December 31, 2009, the Health and
Human Services Commission shall ensure that at least one pilot
project site is in operation under the pilot project required by
Section 531.0525, Government Code, as added by this Act.
SECTION 3. 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 4. 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, 2009.