| 1 | 1 | | By: Nelson S.B. No. 72 |
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| 2 | 2 | | (In the Senate - Filed November 8, 2010; January 31, 2011, |
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| 3 | 3 | | read first time and referred to Committee on Health and Human |
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| 4 | 4 | | Services; March 14, 2011, reported adversely, with favorable |
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| 5 | 5 | | Committee Substitute by the following vote: Yeas 9, Nays 0; |
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| 6 | 6 | | March 14, 2011, sent to printer.) |
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| 7 | 7 | | COMMITTEE SUBSTITUTE FOR S.B. No. 72 By: Nichols |
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| 8 | 8 | | |
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| 9 | 9 | | |
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| 10 | 10 | | A BILL TO BE ENTITLED |
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| 11 | 11 | | AN ACT |
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| 12 | 12 | | relating to streamlining of and utilization management in Medicaid |
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| 13 | 13 | | long-term care waiver programs. |
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| 14 | 14 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 15 | 15 | | SECTION 1. Section 161.077, Human Resources Code, as added |
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| 16 | 16 | | by Chapter 759 (S.B. 705), Acts of the 81st Legislature, Regular |
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| 17 | 17 | | Session, 2009, is redesignated as Section 161.081, Human Resources |
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| 18 | 18 | | Code, and amended to read as follows: |
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| 19 | 19 | | Sec. 161.081 [161.077]. LONG-TERM CARE MEDICAID WAIVER |
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| 20 | 20 | | PROGRAMS: STREAMLINING AND UNIFORMITY. (a) In this section, |
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| 21 | 21 | | "Section 1915(c) waiver program" has the meaning assigned by |
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| 22 | 22 | | Section 531.001, Government Code. |
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| 23 | 23 | | (b) The department, in consultation with the commission, |
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| 24 | 24 | | shall streamline the administration of and delivery of services |
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| 25 | 25 | | through Section 1915(c) waiver programs. In implementing this |
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| 26 | 26 | | subsection, the department, subject to Subsection (c), may consider |
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| 27 | 27 | | implementing the following streamlining initiatives: |
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| 28 | 28 | | (1) reducing the number of forms used in administering |
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| 29 | 29 | | the programs; |
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| 30 | 30 | | (2) revising program provider manuals and training |
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| 31 | 31 | | curricula; |
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| 32 | 32 | | (3) consolidating service authorization systems; |
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| 33 | 33 | | (4) eliminating any physician signature requirements |
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| 34 | 34 | | the department considers unnecessary; |
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| 35 | 35 | | (5) standardizing individual service plan processes |
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| 36 | 36 | | across the programs; [and] |
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| 37 | 37 | | (6) if feasible: |
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| 38 | 38 | | (A) concurrently conducting program |
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| 39 | 39 | | certification and billing audit and review processes and other |
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| 40 | 40 | | related audit and review processes; |
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| 41 | 41 | | (B) streamlining other billing and auditing |
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| 42 | 42 | | requirements; |
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| 43 | 43 | | (C) eliminating duplicative responsibilities |
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| 44 | 44 | | with respect to the coordination and oversight of individual care |
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| 45 | 45 | | plans for persons receiving waiver services; and |
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| 46 | 46 | | (D) streamlining cost reports and other cost |
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| 47 | 47 | | reporting processes; and |
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| 48 | 48 | | (7) any other initiatives that will increase |
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| 49 | 49 | | efficiencies in the programs. |
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| 50 | 50 | | (c) The department shall ensure that actions taken under |
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| 51 | 51 | | Subsection (b) [this section] do not conflict with any requirements |
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| 52 | 52 | | of the commission under Section 531.0218, Government Code. |
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| 53 | 53 | | (d) The department and the commission shall jointly explore |
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| 54 | 54 | | the development of uniform licensing and contracting standards that |
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| 55 | 55 | | would: |
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| 56 | 56 | | (1) apply to all contracts for the delivery of Section |
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| 57 | 57 | | 1915(c) waiver program services; |
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| 58 | 58 | | (2) promote competition among providers of those |
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| 59 | 59 | | program services; and |
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| 60 | 60 | | (3) integrate with other department and commission |
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| 61 | 61 | | efforts to streamline and unify the administration and delivery of |
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| 62 | 62 | | the program services, including those required by this section or |
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| 63 | 63 | | Section 531.0218, Government Code. |
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| 64 | 64 | | SECTION 2. Subchapter D, Chapter 161, Human Resources Code, |
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| 65 | 65 | | is amended by adding Section 161.082 to read as follows: |
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| 66 | 66 | | Sec. 161.082. LONG-TERM CARE MEDICAID WAIVER PROGRAMS: |
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| 67 | 67 | | UTILIZATION REVIEW. (a) In this section, "Section 1915(c) waiver |
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| 68 | 68 | | program" has the meaning assigned by Section 531.001, Government |
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| 69 | 69 | | Code. |
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| 70 | 70 | | (b) The department shall perform utilization review of |
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| 71 | 71 | | services in all Section 1915(c) waiver programs. The utilization |
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| 72 | 72 | | review must include reviewing program recipients' levels of care |
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| 73 | 73 | | and any plans of care for those recipients that exceed service level |
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| 74 | 74 | | thresholds established in the applicable waiver program |
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| 75 | 75 | | guidelines. |
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| 76 | 76 | | SECTION 3. If before implementing any provision of this Act |
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| 77 | 77 | | a state agency determines that a waiver or authorization from a |
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| 78 | 78 | | federal agency is necessary for implementation of that provision, |
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| 79 | 79 | | the agency affected by the provision shall request the waiver or |
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| 80 | 80 | | authorization and may delay implementing that provision until the |
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| 81 | 81 | | waiver or authorization is granted. |
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| 82 | 82 | | SECTION 4. This Act takes effect September 1, 2011. |
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| 83 | 83 | | * * * * * |
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