Texas 2011 - 82nd Regular

Texas Senate Bill SB797 Compare Versions

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1	1	By: Nelson S.B. No. 797
2	2	(In the Senate - Filed February 18, 2011; March 1, 2011,
3	3	read first time and referred to Committee on Health and Human
4	4	Services; April 4, 2011, reported adversely, with favorable
5	5	Committee Substitute by the following vote: Yeas 9, Nays 0;
6	6	April 4, 2011, sent to printer.)
7	7	COMMITTEE SUBSTITUTE FOR S.B. No. 797 By: Nelson
8	8
9	9
10	10	A BILL TO BE ENTITLED
11	11	AN ACT
12	12	relating to objective assessment processes for and appropriate
13	13	provision of acute nursing services and certain other services
14	14	provided under the Medicaid program.
15	15	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	16	SECTION 1. Subchapter B, Chapter 531, Government Code, is
17	17	amended by adding Sections 531.02417, 531.024171, and 531.024172 to
18	18	read as follows:
19	19	Sec. 531.02417. MEDICAID NURSING SERVICES ASSESSMENTS.
20	20	(a) In this section, "acute nursing services" means home health
21	21	skilled nursing services, home health aide services, and private
22	22	duty nursing services.
23	23	(b) The commission shall develop an objective assessment
24	24	process for use in assessing the needs of a Medicaid recipient for
25	25	acute nursing services. The commission shall require that:
26	26	(1) the assessment be conducted:
27	27	(A) by a state employee or contractor who is not
28	28	the person who will deliver any necessary services to the recipient
29	29	and is not affiliated with the person who will deliver those
30	30	services; and
31	31	(B) in a timely manner so as to protect the health
32	32	and safety of the recipient by avoiding unnecessary delays in
33	33	service delivery; and
34	34	(2) the process include:
35	35	(A) an assessment of specified criteria and
36	36	documentation of the assessment results on a standard form;
37	37	(B) an assessment of whether the recipient should
38	38	be referred for additional assessments regarding the recipient's
39	39	needs for therapy services, as defined by Section 531.024171,
40	40	attendant care services, and durable medical equipment; and
41	41	(C) completion by the person conducting the
42	42	assessment of any documents related to obtaining prior
43	43	authorization for necessary nursing services.
44	44	(c) The commission shall:
45	45	(1) implement the objective assessment process
46	46	developed under Subsection (b) within the Medicaid fee-for-service
47	47	model and the primary care case management Medicaid managed care
48	48	model; and
49	49	(2) take necessary actions, including modifying
50	50	contracts with managed care organizations under Chapter 533 to the
51	51	extent allowed by law, to implement the process within the STAR and
52	52	STAR+PLUS Medicaid managed care programs.
53	53	(d) The executive commissioner shall adopt rules providing
54	54	for a process by which a provider of acute nursing services who
55	55	disagrees with the results of the assessment conducted as provided
56	56	by Subsection (b) may request and obtain a review of those results.
57	57	Sec. 531.024171. THERAPY SERVICES ASSESSMENTS. (a) In
58	58	this section, "therapy services" includes occupational, physical,
59	59	and speech therapy services.
60	60	(b) After implementing the objective assessment process for
61	61	acute nursing services as required by Section 531.02417, the
62	62	commission shall consider whether implementing an objective
63	63	assessment process for assessing the needs of a Medicaid recipient
64	64	for therapy services that is comparable to the process required
65	65	under Section 531.02417 for acute nursing services would be
66	66	feasible and beneficial.
67	67	(c) If the commission determines that implementing a
68	68	comparable process with respect to one or more types of therapy
69	69	services is feasible and would be beneficial, the commission may
70	70	implement the process within:
71	71	(1) the Medicaid fee-for-service model;
72	72	(2) the primary care case management Medicaid managed
73	73	care model; and
74	74	(3) the STAR and STAR+PLUS Medicaid managed care
75	75	programs.
76	76	(d) An objective assessment process implemented under this
77	77	section must include a process that allows a provider of therapy
78	78	services to request and obtain a review of the results of an
79	79	assessment conducted as provided by this section that is comparable
80	80	to the process implemented under rules adopted under Section
81	81	531.02417(d).
82	82	Sec. 531.024172. ELECTRONIC VISIT VERIFICATION SYSTEM.
83	83	(a) In this section, "acute nursing services" has the meaning
84	84	assigned by Section 531.02417.
85	85	(b) If it is cost-effective and feasible, the commission
86	86	shall implement an Electronic Visit Verification system to
87	87	electronically verify and document through a telephone or
88	88	computer-based system basic information relating to the delivery of
89	89	Medicaid acute nursing services, including:
90	90	(1) the provider's name;
91	91	(2) the recipient's name; and
92	92	(3) the date and time the provider begins and ends each
93	93	service delivery visit.
94	94	SECTION 2. Not later than September 1, 2012, the Health and
95	95	Human Services Commission shall implement the Electronic Visit
96	96	Verification system required by Section 531.024172, Government
97	97	Code, as added by this Act, if the commission determines that
98	98	implementation of that system is cost-effective and feasible.
99	99	SECTION 3. If before implementing any provision of this Act
100	100	a state agency determines that a waiver or authorization from a
101	101	federal agency is necessary for implementation of that provision,
102	102	the agency affected by the provision shall request the waiver or
103	103	authorization and may delay implementing that provision until the
104	104	waiver or authorization is granted.
105	105	SECTION 4. This Act takes effect September 1, 2011.
106	106	* * * * *