81R3822 UM-D
By: Rose H.B. No. 1589
A BILL TO BE ENTITLED
AN ACT
relating to the creation of a strategic plan to reform long-term
services and supports for individuals with disabilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 536 to read as follows:
CHAPTER 536. STRATEGIC PLAN REGARDING LONG-TERM SERVICES AND
SUPPORTS FOR INDIVIDUALS WITH DISABILITIES
Sec. 536.001. PURPOSE; INTENT. (a) The purpose of this
chapter is to develop a comprehensive plan to reform and rebalance
Texas' system of long-term services and supports for people with
disabilities, including individuals who are eligible for ICF-MR
services.
(b) It is the intent of the legislature that the system
analysis and planning effort prescribed by this chapter encompass
services for individuals with disabilities across different
programs and settings.
(c) It is the intent of the legislature that the reformed
system:
(1) be based on principles of self-determination;
(2) include person-centered planning and maximize
opportunities for consumer direction for all eligible individuals;
(3) provide and expand timely access to services in
the consumer's setting of choice, whether in the community or in an
institution;
(4) base service provision on functional need;
(5) simplify and streamline community-based services
to ensure that, to the extent possible, individuals have access to
the same array of services regardless of an individual's
disability;
(6) improve the quality of services delivered across
programs and settings, with particular attention given to services
delivered to consumers in state schools and state centers;
(7) strengthen oversight of community-based services;
and
(8) increase the cost-effectiveness and
sustainability of long-term care services and supports.
Sec. 536.002. PRINCIPLES OF SELF-DETERMINATION. For
purposes of this chapter, "self-determination" includes the
following principles:
(1) freedom, the opportunity to choose where and with
whom one lives and how one organizes all important aspects of one's
life with freely chosen assistance as needed;
(2) authority, the ability to control some targeted
amount of public dollars;
(3) support, the ability to organize support in ways
that are unique to the individual;
(4) responsibility, the obligation to use public
dollars wisely and to contribute to one's community; and
(5) confirmation, the recognition that individuals
with disabilities must be a major part of the redesign of the human
services system of long-term care.
Sec. 536.003. CREATION OF STRATEGIC PLAN. The commission
shall create a strategic plan for reform of the services and
supports available for persons with disabilities, including
individuals eligible for ICF-MR services. The commission shall
develop the plan using a clearly defined process that allows
ongoing and meaningful statewide public involvement.
Sec. 536.004. CONTENTS OF STRATEGIC PLAN. (a) The
strategic plan required by this chapter must:
(1) assess the need for services and supports based on
current interest lists, national trends, best practices, consumer
satisfaction surveys, and any other relevant data;
(2) prescribe methods to expand timely access to
community-based services by:
(A) eliminating wait times for services of
greater than two years;
(B) transferring funds from institutional to
community-based strategies where appropriate;
(C) developing community-based provider
capacity;
(D) providing incentives for ICF-MR providers to
transition to serving consumers in the most integrated setting;
(E) improving and expanding behavioral supports
in the community for adults and children; and
(F) applying "Money Follows the Person" methods
of financing for persons residing in state schools, state centers,
or public or private ICF-MRs;
(3) analyze current utilization management methods
for community-based services and determine necessary modifications
to ensure more timely access to services;
(4) examine local access issues for community-based
services and identify appropriate solutions;
(5) examine the current functional eligibility
criteria, functional assessment tools, and service planning
reimbursement methodology for the home and community-based
services waiver system and determine appropriate methods to modify
those protocols so individuals can access needed services,
regardless of the program in which the individual is enrolled;
(6) prescribe methods to redesign the home and
community-based services waiver system across all programs by:
(A) simplifying and streamlining the
administrative, policy, and regulatory processes to the extent
possible;
(B) ensuring that person-centered plans and
philosophy match utilization review and utilization management
methods and philosophy;
(C) permitting, to the extent allowed by federal
law, flexibility in the development of a consumer's individualized
service plan based on the needs of the consumer rather than the
consumer's disability label or diagnosis;
(D) ensuring that a consumer's individualized
service plan can be modified when the consumer's support needs
change; and
(E) implementing other strategies to streamline
services for consumers with a disability who are eligible for
waiver services;
(7) prescribe methods to improve services delivered to
consumers in state schools and state centers;
(8) prescribe methods to reduce reliance on
institutional placements of consumers;
(9) prescribe methods to end institutional placements
of individuals who are younger than 22 years of age;
(10) prescribe methods to consolidate and close state
schools and state centers in accordance with Subsection (b);
(11) prescribe methods to downsize large and
medium-sized public and private ICF-MRs;
(12) prescribe methods to improve the quality of
services provided to consumers by:
(A) examining current methods and processes
related to the quality of services and identifying which methods or
processes:
(i) need further enhancements;
(ii) need to be developed; or
(iii) are effective and should be
considered for implementation across all services;
(B) increasing oversight and accountability in
community-based settings;
(C) developing an appropriate population of
qualified direct services workers in the community;
(D) developing and making available alternatives
to guardianship for consumers who need support in their
decision-making; and
(E) identifying quality measures, including
timeliness of service delivery, number of consumers served, and
types of services being received, and providing a process by which
this information is reported to the legislature on an annual basis;
and
(13) identify barriers to system reform and make
recommendations to eliminate or address barriers to system reform,
including any necessary statutory amendment.
(b) The strategic plan must prescribe a method that will
result in the consolidation and closure of state school and state
center facilities through a reduction in the number of consumers
placed in those facilities. In determining the method for
consolidating and closing state school and state center facilities,
the plan must:
(1) establish a goal of reducing, within eight years
of the submission of the strategic plan, the utilization rate of
state schools and other facilities with 16 or more beds to not more
than the average national utilization rate;
(2) establish benchmarks that will demonstrate
measurable progress during the eight-year period following the
submission of the strategic plan toward the reduction of the
utilization rate of state schools and other facilities with 16 or
more beds;
(3) reflect the recommendations of a steering
committee that includes:
(A) as appointed by the speaker of the house of
representatives:
(i) one member representing a district in
which a state school or state center is located; and
(ii) one member representing a district in
which no state school or state center is located;
(B) as appointed by the lieutenant governor:
(i) one senator representing a district in
which a state school or state center is located; and
(ii) one senator representing a district in
which no state school or state center is located;
(C) as appointed by the executive commissioner,
one representative of:
(i) providers of community-based services;
(ii) providers of ICF-MR services;
(iii) state school employees;
(iv) consumers;
(v) advocates for consumers;
(vi) advocates for consumers who are
children;
(vii) families of residents of a state
school located in a rural area;
(viii) families of residents of a state
school located in an urban area; and
(ix) local mental retardation authorities;
and
(D) for the purpose of providing assistance and
serving as a resource to the steering committee, representatives of
relevant agencies, including the Texas Department of Housing and
Community Affairs and other agencies other than the commission, as
determined by the other members of the steering committee;
(4) require the executive commissioner to appoint or
hire a person, who is not an employee of the Department of Aging and
Disability Services, to oversee the closure process;
(5) identify the number and location of state schools
and state centers that will be closed under the plan and the
timeline for each closure;
(6) establish guiding principles for state schools and
state centers that will be closed under the plan, including
guidelines for the future use of closed facilities and principles
addressing the needs of:
(A) residents and their families;
(B) employees; and
(C) affected communities;
(7) define transitional supports, including
employment supports, that will be made available to a state school
or state center resident who moves from a state school or state
center; and
(8) prescribe methods to provide consumers in state
schools or state centers who do not have a legally authorized
representative with access to alternatives to guardianship.
(c) The strategic plan must establish a timeline and defined
benchmarks for measuring progress in implementing the plan. The
executive commissioner shall ensure that the plan includes an
ongoing evaluation process that allows the plan to be amended in
response to needs identified by the process. The proposed timeline
and benchmarks must progressively move the state closer to the goal
of reducing the utilization rate of state schools and other
facilities with 16 or more beds to a rate that is not more than the
national utilization rate and to the goal of reducing wait times for
community-based services. The plan must require the commission to
inform the governor, the lieutenant governor, the speaker of the
house of representatives, the Legislative Budget Board, and the
standing committees of both houses of the legislature with
appropriate subject matter jurisdiction when significant revisions
to the strategic plan are made or when a proposed timeline is not
met.
(d) The executive commissioner, in developing the strategic
plan, shall consider the efforts of other states, Texas' settlement
of Lelsz v. Kavanagh, and any relevant directives or information
resulting from the investigation of state school or state center
facilities by the United States Department of Justice.
(e) The executive commissioner may contract with a
disinterested person with expertise in evaluating and planning
long-term care services and supports for persons with disabilities,
self-determination and consumer direction, and facilities
closures, to aid the commission in developing the plan required by
this chapter.
Sec. 536.005. CLOSURE OR CONSOLIDATION OF CERTAIN
FACILITIES. As soon as possible after the commission submits the
strategic plan required by this chapter, the executive commissioner
shall begin the facility closure process described by the plan. The
commission may begin the implementation of the plan and close or
consolidate a facility as described by the plan without additional
or specific legislative action.
SECTION 2. Not later than December 1, 2010, the Health and
Human Services Commission shall submit the strategic plan required
by Chapter 536, Government Code, as added by this Act, to the
presiding officers of the Senate Health and Human Services
Committee and the House Human Services Committee.
SECTION 3. 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.