84R29008 JSL-F
By: Schwertner, et al. S.B. No. 1385
(Price, Naishtat, Raymond)
Substitute the following for S.B. No. 1385: No.
A BILL TO BE ENTITLED
AN ACT
relating to the authorization of the imposition of administrative
penalties on providers participating in certain Medicaid waiver
programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 161, Human Resources Code,
is amended by adding Section 161.088 to read as follows:
Sec. 161.088. ADMINISTRATIVE PENALTIES. (a) This section
applies to the following waiver programs established under Section
1915(c), Social Security Act (42 U.S.C. Section 1396n(c)), and
administered by the department to serve persons with an
intellectual or developmental disability:
(1) the home and community-based services (HCS) waiver
program; and
(2) the Texas home living (TxHmL) waiver program.
(b) The department may assess and collect an administrative
penalty against a provider who participates in a program to which
this section applies for a violation of a law or rule relating to
the program. If the department assesses an administrative penalty
against a provider for a violation of a law or rule, the department
may not impose a payment hold against or otherwise withhold
contract payments from the provider for the same violation of a law
or rule.
(c) After consulting with appropriate stakeholders, the
executive commissioner shall develop and adopt rules regarding the
imposition of administrative penalties under this section. The
rules must:
(1) specify the types of violations that warrant
imposition of an administrative penalty;
(2) establish a schedule of progressive
administrative penalties in accordance with the relative type,
frequency, and seriousness of a violation;
(3) prescribe reasonable amounts to be imposed for
each violation giving rise to an administrative penalty, subject to
Subdivision (4);
(4) authorize the imposition of an administrative
penalty in an amount not to exceed $5,000 for each violation;
(5) provide that a provider commits a separate
violation each day the provider continues to violate the law or
rule;
(6) ensure standard and consistent application of
administrative penalties throughout the state; and
(7) provide for an administrative appeals process to
adjudicate claims and appeals relating to the imposition of an
administrative penalty under this section that is in accordance
with Chapter 2001, Government Code.
(d) In specifying the types of violations that warrant
imposition of an administrative penalty under Subsection (c), the
executive commissioner shall specify the types of minor violations
that allow a provider an opportunity to take corrective action
before a penalty is imposed.
(e) In establishing the schedule of progressive
administrative penalties and penalty amounts under Subsection (c),
the executive commissioner must consider:
(1) the seriousness of a violation, including:
(A) the nature, circumstances, extent, and
gravity of the violation; and
(B) the hazard to the health or safety of
recipients resulting from the violation;
(2) the provider's history of previous violations;
(3) whether the provider:
(A) had prior knowledge of the violation,
including whether the provider identified the violation through the
provider's internal quality assurance process; and
(B) made any efforts to mitigate or correct the
identified violation;
(4) the penalty amount necessary to deter future
violations; and
(5) any other matter justice may require.
(f) In lieu of imposing an administrative penalty under this
section, the department shall allow a provider found to have
committed a minor violation specified by rule in accordance with
Subsection (d) to have a reasonable period of time that is not less
than 45 days after the date the department sends notice to the
provider of the violation to take corrective action regarding the
violation. The department may not allow time for corrective action
for any violation that is not a minor violation.
SECTION 2. The Department of Aging and Disability Services
may impose an administrative penalty in accordance with Section
161.088, Human Resources Code, as added by this Act, only for
conduct that occurs on or after the effective date of this Act.
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, 2015.