84R5302 LEH-F
By: Naishtat H.B. No. 1873
A BILL TO BE ENTITLED
AN ACT
relating to a pilot project to evaluate the use of self-directed
mental health services in the integrated Medicaid managed care
system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 1001, Health and Safety
Code, is amended by adding Section 1001.085 to read as follows:
Sec. 1001.085. SELF-DIRECTED MENTAL HEALTH SERVICES PILOT
PROJECT. (a) The commission and the department jointly shall
develop and implement a four-year pilot project for self-directed
mental health services in the integrated Medicaid managed care
system to maximize patient choice and encourage personal
responsibility for achieving recovery.
(b) To be eligible to participate in the pilot project, an
individual must:
(1) be at least 18 years of age;
(2) have a serious mental illness, as defined by
Section 1355.001, Insurance Code; and
(3) be receiving Medicaid rehabilitative services
through a local mental health authority.
(c) Participation in the pilot project by an individual is
voluntary, and the decision whether to participate may be made only
by the individual or the individual's legally authorized
representative.
(d) The commission and the department shall develop the
pilot project with input from relevant stakeholders, including
patients, advocates, Medicaid managed care organizations,
providers, and local mental health authorities.
(e) The pilot project as implemented must include:
(1) person-centered planning to assist each
participant in identifying recovery goals and the specific services
and supports needed to accomplish those goals;
(2) the development of an individualized budget for
each participant that is based on the goals identified in
Subdivision (1) and of which some percentage less than 50 may be
spent on nontraditional goods and services that the participant
generally would not receive as part of a package of outpatient
mental health services delivered through a local mental health
authority;
(3) guidelines for nontraditional goods and services
that may be purchased with a participant's individualized budget to
ensure that nontraditional goods and services purchased are
directly related to the participant's recovery goals;
(4) the option for a participant to use a life coach to
assist with:
(A) person-centered planning;
(B) budgeting;
(C) identifying and navigating community
services;
(D) recruiting, hiring, and releasing service
providers;
(E) crisis planning; and
(F) interactions with the fiscal intermediary
designated in accordance with Subdivision (7) and billing for goods
and services;
(5) specific qualifications for a life coach to be
eligible to provide services to a participant;
(6) the option for a participant to receive services
from a certified peer specialist;
(7) the designation of a fiscal intermediary who
provides financial management and billing support for the project;
and
(8) a plan for budget neutrality by the end of the
second year of the project.
(f) The commission and the department shall select the pilot
project site based on a competitive application process among the
local mental health authorities. Applications must include
evidence of significant patient and certified peer specialist
participation in the preparation of the application. The
commission and the department shall select as the pilot project
site an area of this state where the local mental health authority
and Medicaid managed care providers have a strong partnership and
where there is a high commitment to the success of the project.
(g) The commission and the department shall collect
information relating to the pilot project, including information
relating to recovery-focused outcome metrics and to the costs of
the project.
(h) Not later than one year after the date the pilot project
concludes, the commission and the department shall submit to the
legislature a report evaluating the pilot project, particularly
with regard to cost-effectiveness and recovery-focused outcomes.
In developing the report, the commission and the department shall
seek private funding and support to assist with the evaluation
process.
(i) The executive commissioner, with input from patients
receiving mental health services, certified peer specialists, and
other interested stakeholders, shall adopt rules necessary to
implement the pilot project developed under this section.
SECTION 2. As soon as practicable after the effective date
of this Act, the Health and Human Services Commission and the
Department of State Health Services shall begin developing and
implementing the pilot project under Section 1001.085, Health and
Safety Code, as added by this Act.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2015.