81R33511 JSC-D
By: Van de Putte, et al. S.B. No. 1648
Substitute the following for S.B. No. 1648:
By: Kolkhorst C.S.S.B. No. 1648
A BILL TO BE ENTITLED
AN ACT
relating to providing outreach services, service coordination for
behavioral health services and other health care services related
to mental health, and related information to members and veterans
of the armed forces and their families, creating a pilot program for
provision of related behavioral health services, and providing for
the creation of related clinical practice guidelines.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Title 12, Health and Safety Code, is amended by
designating Chapter 1001, Health and Safety Code, as Subtitle A and
adding a heading for Subtitle A to read as follows:
SUBTITLE A. ADMINISTRATION BY DEPARTMENT
SECTION 2. Title 12, Health and Safety Code, is amended by
adding Subtitle B to read as follows:
SUBTITLE B. DEPARTMENT OF STATE HEALTH SERVICES PROGRAMS
CHAPTER 1022. SERVICES FOR SERVICEMEMBERS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1022.001. DEFINITIONS. In this chapter:
(1) "Department" means the Department of State Health
Services.
(2) "Post-traumatic stress disorder" means a
psychiatric disorder that can occur in people who have experienced
or witnessed life-threatening events, including natural disasters,
serious accidents, terrorist incidents, war, or violent personal
assaults.
(3) "Program" means the program established under this
chapter.
(4) "Servicemember" has the meaning assigned by
Section 161.551.
(5) "Traumatic brain injury" means an acquired injury
to the brain, including brain injuries caused by anoxia due to near
drowning. The term does not include brain dysfunction caused by
congenital or degenerative disorders or birth trauma.
Sec. 1022.002. RULES. The executive commissioner of the
Health and Human Services Commission shall adopt rules to implement
this chapter.
Sec. 1022.003. CREATION AND PURPOSE. The department shall
establish a program under this chapter to promote the wellness of
servicemembers and their families through the development,
maintenance, and dissemination of clinical practice guidelines and
other information for the effective treatment of psychological
trauma and the reintegration of servicemembers into their
communities, families, and workplaces, with emphasis on the trauma
of war, including post-traumatic stress disorder, traumatic brain
injury, and sexual trauma that occurs in military settings.
[Sections 1022.004-1022.050 reserved for expansion]
SUBCHAPTER B. CLINICAL PRACTICE GUIDELINES FOR TRAUMA
Sec. 1022.051. CLINICAL GUIDELINES. (a) The department
shall develop evidence-based clinical practice guidelines
containing recommendations to clinicians and other providers of
mental health services for the management of trauma, including
post-traumatic stress disorder, traumatic brain injury, and other
trauma impacting behavioral health.
(b) In developing clinical practice guidelines, the
department shall consider the recommendations and research of the
National Center for Posttraumatic Stress Disorder of the federal
Veterans Health Administration, the trauma registry and research
database of the United States Army Institute of Surgical Research,
and other appropriate and reputable sources of clinical research
and information as determined by the department.
(c) The department shall provide for the ongoing
maintenance and updating of the clinical practice guidelines in a
manner that reflects current diagnostic and treatment best
practices.
(d) Clinical practice guidelines established under this
subchapter do not constitute the sole source of guidance in the
management of trauma. Guidelines are intended to assist clinicians
by providing a framework for clinical decision making. These
guidelines do not provide the only appropriate approach to the
management of trauma or replace other clinical judgment.
Sec. 1022.052. DISSEMINATION OF GUIDELINES. (a) The
department shall make the clinical practice guidelines and other
information developed under this subchapter available to providers
of physical and behavioral health services.
(b) The department shall provide the clinical practice
guidelines and information to the appropriate professional
associations to be used in continuing education and shall, to the
extent feasible, enter into agreements or take other action to
promote the use of the materials for continuing education purposes.
(c) The department or its designees shall provide training
and continuing education to clinicians and shall recognize through
certificates or other means the health care providers that have
demonstrated knowledge and mastery of the clinical practice
guidelines and other materials developed by the department for the
program.
Sec. 1022.053. TRAINING AND EDUCATIONAL MATERIALS. In
addition to clinical practice guidelines, the department shall
develop, with the advice of and in consultation with the Texas
Veterans Commission, training and educational materials for the use
of the Texas Veterans Commission, veterans county service officers,
and other service providers. The materials must promote the
understanding and effective treatment of trauma affecting
behavioral health and other health-related information pertaining
to the reintegration of servicemembers into their communities,
families, and workplaces.
[Sections 1022.054-1022.100 reserved for expansion]
SUBCHAPTER C. SERVICE COORDINATION FOR BEHAVIORAL
HEALTH SERVICES
Sec. 1022.101. SERVICE COORDINATION. (a) The department,
in consultation with the United States Department of Veterans
Affairs, the Texas military forces, the Texas Information and
Referral Network, the Texas Veterans Commission, and the General
Land Office, shall provide service coordination for servicemembers
and their families in all geographic regions of the state to connect
them to behavioral health services that may be available through
the United States Department of Veterans Affairs or available under
this chapter.
(b) In geographic areas in this state in which services are
not yet available or accessible through the United States
Department of Veterans Affairs, the department shall negotiate
contracts with the United States Department of Veterans Affairs for
behavioral health services provided through community mental
health centers or other community resources with which the
department contracts until federal services are available.
(c) The department shall provide servicemembers and their
families current, accurate, and complete information about
behavioral health services and resources through existing
Internet-based resource programs and through:
(1) the directory of services for military personnel
and their families disseminated through the Texas Information and
Referral Network under Subchapter U, Chapter 161; and
(2) the service referral program under Section
431.0291, Government Code, as added by Chapter 1381 (S.B. 1058),
Acts of the 80th Legislature, Regular Session, 2007.
(d) The department shall seek reimbursement for the costs of
services provided under this section from the United States
Department of Veterans Affairs and from other governmental agencies
that may provide behavioral health services or payments for such
services to servicemembers and their families.
(e) In order to enhance service coordination and assess the
needs of servicemembers and their families, the department shall
provide an opportunity for servicemembers to disclose military
status when accessing local behavioral health services that receive
funding from the department.
[Sections 1022.102-1022.150 reserved for expansion]
SUBCHAPTER D. BEHAVIORAL HEALTH SERVICES PILOT PROGRAMS
Sec. 1022.151. ESTABLISHMENT OF PILOT PROGRAMS. (a) The
department shall establish pilot programs in El Paso and Bexar
Counties to evaluate the effectiveness of a program to provide
behavioral health services to eligible servicemembers.
(b) The department shall contract with the local mental
health authorities in El Paso and Bexar Counties to administer the
pilot programs.
Sec. 1022.152. ELIGIBILITY. (a) To qualify for behavioral
health services under Section 1022.153, a servicemember must:
(1) reside in El Paso or Bexar County;
(2) be younger than 65 years of age;
(3) have served for at least 180 days of duty after the
servicemember's initial training;
(4) not be an inmate of a public institution;
(5) not be a resident of a nursing facility;
(6) not have health care coverage that provides
diagnostic review and treatment for post-traumatic stress
disorder, traumatic brain injury, or other trauma occurring in a
military setting that impacts behavioral health; and
(7) be ineligible for services from the United States
Department of Veterans Affairs or be unable to access those
services because:
(A) the servicemember does not have
transportation to a service provider; or
(B) the servicemember must wait more than 30 days
for an appointment with a service provider.
(b) A servicemember who does not meet the eligibility
requirements for services under this section shall be referred to
an appropriate service provider for follow-up care.
(c) To receive behavioral health services under Section
1022.153, an eligible servicemember must enroll with the local
mental health authority in the pilot program. Following expiration
of the term of a servicemember's enrollment in the pilot program,
the servicemember may reenroll for services under the pilot program
if the local mental health authority determines that the
servicemember continues to qualify for treatment for
post-traumatic stress disorder, traumatic brain injury, or other
trauma occurring in a military setting that impacts behavioral
health.
(d) A family member of an enrolled servicemember may receive
behavioral health services under the pilot program as described by
Section 1022.153.
Sec. 1022.153. BEHAVIORAL HEALTH SERVICES PILOT PROGRAMS.
(a) The department through contracts with the local mental health
authorities in El Paso and Bexar Counties shall establish pilot
programs to provide behavioral health services in accordance with
this section for eligible servicemembers under Section 1022.152.
The behavioral health services provided under this section may
include:
(1) crisis services; and
(2) behavioral health services.
(b) The behavioral health services provided under
Subsection (a)(2) must to the greatest extent possible be provided
in a peer-based treatment environment and may include:
(1) screening assessments;
(2) individual, family, and group therapy;
(3) substance abuse early intervention and
detoxification services; and
(4) substance abuse medication-assisted treatment.
(c) The provision of services by the local mental health
authority under this section must be based on medical necessity
criteria established by department rule.
(d) The department shall seek reimbursement for the costs of
services provided under this section from the United States
Department of Veterans Affairs and from other governmental agencies
that may provide behavioral health services or payments for such
services to servicemembers and their families.
Sec. 1022.154. REPORT. Not later than December 1, 2010, the
department shall submit a report to the governor, lieutenant
governor, and speaker of the house of representatives that
includes:
(1) an analysis of the effectiveness of the pilot
program under this subchapter; and
(2) recommendations regarding continuation or
expansion of the pilot program.
Sec. 1022.155. EXPIRATION. This subchapter expires
September 1, 2011.
[Sections 1022.156-1022.200 reserved for expansion]
SUBCHAPTER E. BEHAVIORAL HEALTH OUTREACH
Sec. 1022.201. OUTREACH ACTIVITIES. (a) Through a public
outreach program, the department shall provide to servicemembers
and their families information on accessing services through the
Texas Information and Referral Network and through other
organizations participating in memoranda of understanding
maintained by the Texas military forces.
(b) The department's outreach activities must describe
programs administered by health and human services agencies that
could be of interest to servicemembers and their families,
including early childhood intervention services, state vocational
rehabilitation services, and higher education benefits and support
services.
(c) The department's outreach efforts must be:
(1) conducted on a statewide basis;
(2) conducted through a contract or contracts with
statewide or local community-based organizations with experience
in statewide outreach to the military; and
(3) staffed by individuals with demonstrated
experience in working with the military and military service
organizations.
(d) Outreach methods must include direct personal contacts
with servicemembers and outreach using communications media and
printed materials. As a component of the department's outreach
activities, the department shall maintain or support an existing
interactive Internet-based resource program that:
(1) allows individuals to access comprehensive
information, advocacy resources, and other resources regarding
public and private behavioral health services, crisis and emergency
services, and early intervention and prevention programs; and
(2) enables the public and private health care
communities to work together to address the problems related to
obtaining access to behavioral health services and other
reintegration services for servicemembers and their families.
(e) The interactive Internet-based program established
under Subsection (d) shall be developed or maintained by the
department with the advice of and in consultation with the Texas
military forces. The department shall collaborate with state
agencies and the Texas military forces to develop strategies to use
existing interactive Internet-based resources that serve
servicemembers and their families.
SECTION 3. Subchapter A, Chapter 431, Government Code, is
amended by adding Section 431.0186 to read as follows:
Sec. 431.0186. SCREENING FOR TRAUMATIC BRAIN INJURY.
(a) The adjutant general shall require each member of the Texas
National Guard who served during Operation Enduring Freedom or
Operation Iraqi Freedom to be screened for traumatic brain injury.
(b) The adjutant general shall assist a member of the Texas
National Guard who tests positive for traumatic brain injury in
obtaining appropriate medical care.
SECTION 4. Section 434.007, Government Code, is amended to
read as follows:
Sec. 434.007. DUTIES. (a) The commission shall:
(1) compile federal, state, and local laws enacted to
benefit members of the armed forces, veterans, and their families
and dependents;
(2) collect information relating to services and
facilities available to veterans;
(3) cooperate with veterans service agencies in the
state;
(4) inform members and veterans of the armed forces,
their families and dependents, and military and civilian
authorities about the existence or availability of:
(A) educational training and retraining
facilities;
(B) health, medical, rehabilitation, and housing
services and facilities;
(C) employment and reemployment services;
(D) provisions of federal, state, and local law
affording rights, privileges, and benefits to members and veterans
of the armed forces and their families and dependents; and
(E) other similar, related, or appropriate
matters;
(5) assist veterans and their families and dependents
in presenting, proving, and establishing claims, privileges,
rights, and benefits they may have under federal, state, or local
law, including establishing eligibility for health care services
and treatments from the federal Veterans Health Administration and
for services provided through the Department of State Health
Services;
(6) cooperate with all government and private agencies
securing services or benefits to veterans and their families and
dependents;
(7) investigate, and if possible correct, abuses or
exploitation of veterans or their families or dependents, and
recommend necessary legislation for full correction;
(8) coordinate the services and activities of state
departments and divisions having services and resources affecting
veterans or their families or dependents;
(9) provide training and certification of veterans
county service officers and assistant veterans county service
officers in accordance with Section 434.038; and
(10) through surveys or other reasonable and accurate
methods of estimation, collect and maintain for each county in the
state the number of servicemembers and veterans residing in the
county and annually update and publish the information on the
commission's website.
(b) The commission shall enter into a memorandum of
understanding with the Department of State Health Services to
develop training materials for veterans county service officers and
veterans service organizations that promote the understanding and
effective treatment of trauma affecting behavioral health and other
health-related information that promotes the reintegration of
members and veterans of the armed forces into their communities,
families, and workplaces. The commission shall:
(1) disseminate training and educational materials
for the development of clinical practice guidelines and other
training and educational materials that it receives from the
department;
(2) enter into a contract or other agreement for the
development of the training and educational materials with the
department;
(3) reimburse the department for costs of preparing
the materials from appropriations or other amounts available to the
commission; and
(4) enter into relationships with established
training programs for the purpose of providing peer support
training and certification for veterans county service officers.
SECTION 5. Subsection (a), Section 434.0078, Government
Code, is amended to read as follows:
(a) The commission shall adopt procedures for administering
claims assistance services under Section 434.007(5). Claims
assistance services shall be provided for establishing eligibility
for health care services and treatments from the federal Veterans
Health Administration. The procedures shall include:
(1) criteria for determining when a veteran's initial
claim is substantially complete and basic eligibility requirements
are met as provided by federal law;
(2) a process for expediting a claim based on
hardship, including whether the veteran:
(A) is in immediate need;
(B) is terminally ill;
(C) has a verifiable financial hardship; or
(D) has a disability that presents an undue
burden;
(3) a procedure for counseling veterans on the
potential merits or drawbacks of pursuing a claim;
(4) a process to ensure adequate documentation and
development of a claim or appeal, including early client
involvement, collection of needed evidence and records, and
analysis of actions necessary to pursue and support a claim or
appeal;
(5) criteria for evaluating whether a decision of the
United States Department of Veterans Affairs contains sufficient
cause for filing an appeal;
(6) a requirement that a claims counselor report to
the United States Department of Veterans Affairs if the counselor
has direct knowledge that a claim contains false or deceptive
information; and
(7) a procedure for prioritizing a claim, when
appropriate, or providing an alternative source for obtaining
claims assistance services when it is not appropriate to
prioritize.
SECTION 6. The Department of State Health Services shall
conduct an immediate analysis of the behavioral health needs of
servicemembers and their families and submit a preliminary report
of its findings and recommendations to the legislature and the
governor on or before December 1, 2009, and a final report of its
findings and recommendations on or before December 1, 2010. The
report shall:
(1) identify the gaps in behavioral health services
available to servicemembers and their families;
(2) identify impediments to the ability of
servicemembers and their families to access the behavioral health
services that are available, particularly in the state's rural
areas;
(3) evaluate collaboration among organizations and
entities that provide behavioral health services to servicemembers
and their families;
(4) make recommendations with respect to improving
outreach to servicemembers and their families in need of behavioral
health services;
(5) include a specific plan of action to promote
federal and state collaboration to maximize funding and access to
resources for the behavioral health needs of servicemembers and
their families;
(6) make recommendations with respect to building
provider capacity and increasing provider training to meet the
behavioral health needs of servicemembers and their families
through peer support treatment methodologies; and
(7) make recommendations with respect to improving the
coordination of behavioral health services for servicemembers and
their families.
SECTION 7. Not later than January 1, 2010, the executive
commissioner of the Health and Human Services Commission shall
adopt rules as necessary to administer Chapter 1022, Health and
Safety Code, as added by this Act.
SECTION 8. This Act does not make an appropriation. This
Act takes effect only if a specific appropriation for the
implementation of the Act is provided in a general appropriations
act of the 81st Legislature.
SECTION 9. Except as provided by Section 8 of this Act, this
Act takes effect September 1, 2009.