By: Nelson S.B. No. 72
A BILL TO BE ENTITLED
AN ACT
relating to streamlining of and utilization management in Medicaid
long-term care waiver programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 161.077, Human Resources Code, as added
by Chapter 759 (S.B. 705), Acts of the 81st Legislature, Regular
Session, 2009, is redesignated as Section 161.081, Human Resources
Code, and amended to read as follows:
Sec. 161.081 [161.077]. LONG-TERM CARE MEDICAID WAIVER
PROGRAMS: STREAMLINING AND UNIFORMITY. (a) In this section,
"Section 1915(c) waiver program" has the meaning assigned by
Section 531.001, Government Code.
(b) The department, in consultation with the commission,
shall streamline the administration of and delivery of services
through Section 1915(c) waiver programs. In implementing this
subsection, the department, subject to Subsection (c), may consider
implementing the following streamlining initiatives:
(1) reducing the number of forms used in administering
the programs;
(2) revising program provider manuals and training
curricula;
(3) consolidating service authorization systems;
(4) eliminating any physician signature requirements
the department considers unnecessary;
(5) standardizing individual service plan processes
across the programs; [and]
(6) if feasible:
(A) concurrently conducting program
certification and billing audit and review processes and other
related audit and review processes;
(B) streamlining other billing and auditing
requirements;
(C) eliminating duplicative responsibilities
with respect to the coordination and oversight of individual care
plans for persons receiving waiver services; and
(D) streamlining cost reports and other cost
reporting processes; and
(7) any other initiatives that will increase
efficiencies in the programs.
(c) The department shall ensure that actions taken under
Subsection (b) [this section] do not conflict with any requirements
of the commission under Section 531.0218, Government Code.
(d) The department and the commission shall jointly explore
the development of uniform licensing and contracting standards that
would:
(1) apply to all contracts for the delivery of Section
1915(c) waiver program services;
(2) promote competition among providers of those
program services; and
(3) integrate with other department and commission
efforts to streamline and unify the administration and delivery of
the program services, including those required by this section or
Section 531.0218, Government Code.
SECTION 2. Subchapter D, Chapter 161, Human Resources Code,
is amended by adding Section 161.082 to read as follows:
Sec. 161.082. LONG-TERM CARE MEDICAID WAIVER PROGRAMS:
UTILIZATION REVIEW. (a) In this section, "Section 1915(c) waiver
program" has the meaning assigned by Section 531.001, Government
Code.
(b) The department shall perform utilization review of
services in all Section 1915(c) waiver programs. The utilization
review must include reviewing program recipients' levels of care
and any plans of care for those recipients that exceed service level
thresholds established in the applicable waiver program
guidelines.
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 September 1, 2011.