By: Zaffirini S.B. No. 775
A BILL TO BE ENTITLED
AN ACT
relating to establishing a participant-directed Medicaid waiver
pilot program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0511 to read as follows:
Sec. 531.0511. PARTICIPANT-DIRECTED MEDICAID WAIVER PILOT
PROGRAM. (a) The commission, in consultation with the consumer
direction work group created under Section 531.052, shall develop
and implement a pilot program that allows Medicaid recipients who
participate in any Section 1915(c) waiver program to have greater
choice, direction, and control over the Medicaid benefits they
receive than is available under the consumer direction models
offered under Section 531.051. The pilot program must:
(1) be operated in one rural area and one urban area of
the state;
(2) be operated for a period of at least four years;
(3) in addition to offering consumer-directed service
options, as defined by Section 531.051, allow a program participant
to:
(A) purchase participant-directed goods and
services that address the needs identified in the participant's
individual service plan using money that:
(i) is allocated to the participant through
an individual budget; and
(ii) represents amounts that would be spent
providing Medicaid services to the participant in the absence of
the pilot program; and
(B) employ, as the participant determines is
appropriate, a household member, including the participant's
spouse, to provide direct services to the participant under the
participant's individual service plan, provided the household
member is 18 years of age or older;
(4) make available to each program participant a
support advisor for purposes of:
(A) verifying the participant's allocated
budget;
(B) assisting the participant in developing the
participant's individual service plan based on the participant's
allocated budget; and
(C) coordinating the service and support
providers and goods selected by the participant as part of the
participant's individual service plan; and
(5) employ strategies designed to achieve the
following goals:
(A) improving the health outcomes of program
participants;
(B) improving program participant access to
services;
(C) achieving cost containment and efficiency;
and
(D) reducing the administrative complexity of
delivering benefits under the Medicaid program.
(b) Not later than September 1, 2016, the commission shall
submit to the legislature a report regarding the results of the
pilot program. The report must include:
(1) a summary of the strategies employed to achieve
the program goals described by Subsection (a)(5);
(2) an analysis of data collected during the operation
of the program and the capability of the data to measure achievement
of the program goals;
(3) a recommendation regarding the continued
operation of the program; and
(4) a recommendation regarding whether the program
should be implemented statewide.
(c) This section expires September 1, 2017.
SECTION 2. The Health and Human Services Commission shall
apply for and actively pursue a waiver or other authorization to the
state Medicaid plan from the federal Centers for Medicare and
Medicaid Services or any other federal agency as necessary to
implement the participant-directed Medicaid waiver pilot program
under Section 531.0511, Government Code, as added by this Act, and
may delay implementing that provision until the waiver or other
authorization is granted.
SECTION 3. This Act takes effect September 1, 2011.