By: Nelson S.B. No. 797
A BILL TO BE ENTITLED
AN ACT
relating to objective assessment processes for and appropriate
provision of acute nursing services and certain other services
provided under the Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.02417, 531.024171, and 531.024172 to
read as follows:
Sec. 531.02417. MEDICAID NURSING SERVICES ASSESSMENTS.
(a) In this section, "acute nursing services" means home health
skilled nursing services, home health aide services, and private
duty nursing services.
(b) The commission shall develop an objective assessment
process for use in assessing the needs of a Medicaid recipient for
acute nursing services. The commission shall require that:
(1) the assessment be conducted:
(A) by a state employee or contractor who is not
the person who will deliver any necessary services to the recipient
and is not affiliated with the person who will deliver those
services; and
(B) in a timely manner so as to protect the health
and safety of the recipient by avoiding unnecessary delays in
service delivery; and
(2) the process include:
(A) an assessment of specified criteria and
documentation of the assessment results on a standard form;
(B) an assessment of whether the recipient should
be referred for additional assessments regarding the recipient's
needs for therapy services, as defined by Section 531.024171,
attendant care services, and durable medical equipment; and
(C) completion by the person conducting the
assessment of any documents related to obtaining prior
authorization for necessary nursing services.
(c) The commission shall:
(1) implement the objective assessment process
developed under Subsection (b) within the Medicaid fee-for-service
model and the primary care case management Medicaid managed care
model; and
(2) take necessary actions, including modifying
contracts with managed care organizations under Chapter 533 to the
extent allowed by law, to implement the process within the STAR and
STAR+PLUS Medicaid managed care programs.
(d) The executive commissioner shall adopt rules providing
for a process by which a provider of acute nursing services who
disagrees with the results of the assessment conducted as provided
by Subsection (b) may request and obtain a review of those results.
Sec. 531.024171. THERAPY SERVICES ASSESSMENTS. (a) In
this section, "therapy services" includes occupational, physical,
and speech therapy services.
(b) After implementing the objective assessment process for
acute nursing services as required by Section 531.02417, the
commission shall consider whether implementing an objective
assessment process for assessing the needs of a Medicaid recipient
for therapy services that is comparable to the process required
under Section 531.02417 for acute nursing services would be
feasible and beneficial.
(c) If the commission determines that implementing a
comparable process with respect to one or more types of therapy
services is feasible and would be beneficial, the commission may
implement the process within:
(1) the Medicaid fee-for-service model;
(2) the primary care case management Medicaid managed
care model; and
(3) the STAR and STAR+PLUS Medicaid managed care
programs.
(d) An objective assessment process implemented under this
section must include a process that allows a provider of therapy
services to request and obtain a review of the results of an
assessment conducted as provided by this section that is comparable
to the process implemented under rules adopted under Section
531.02417(d).
Sec. 531.024172. ELECTRONIC VISIT VERIFICATION SYSTEM.
(a) In this section, "acute nursing services" has the meaning
assigned by Section 531.02417.
(b) If it is cost-effective and feasible, the commission
shall implement an Electronic Visit Verification system to
electronically verify and document through a telephone or
computer-based system basic information relating to the delivery of
Medicaid acute nursing services, including:
(1) the provider's name;
(2) the recipient's name; and
(3) the date and time the provider begins and ends each
service delivery visit.
SECTION 2. Not later than September 1, 2012, the Health and
Human Services Commission shall implement the Electronic Visit
Verification system required by Section 531.024172, Government
Code, as added by this Act, if the commission determines that
implementation of that system is cost-effective and feasible.
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.