85R5422 JG-F
By: Raymond H.B. No. 2590
A BILL TO BE ENTITLED
AN ACT
relating to the amelioration and informal dispute resolution
processes for 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 Sections 161.0891 and 161.0892 to read as
follows:
Sec. 161.0891. AMELIORATION PROCESS. (a) In lieu of
demanding payment of an administrative penalty assessed under
Section 161.089, the commission may, in accordance with this
section, allow the provider subject to the penalty to use, under the
supervision of the commission, any portion of the amount of the
penalty to ameliorate the violation or to improve services in the
waiver program in which the provider participates.
(b) The commission shall offer amelioration to a provider
under this section not later than the 10th day after the date the
provider receives from the commission a final notification of the
assessment of an administrative penalty that is sent to the
provider after an informal dispute resolution process but before an
administrative hearing.
(c) A provider to whom amelioration has been offered must
file a plan for amelioration not later than the 45th day after the
date the provider receives the offer of amelioration from the
commission. In submitting the plan, the provider must agree to
waive the provider's right to an administrative hearing if the
commission approves the plan.
(d) At a minimum, a plan for amelioration must:
(1) propose changes to the management or operation of
the waiver program in which the provider participates that will
improve services to or quality of care for clients in the program;
(2) identify, through measurable outcomes, the ways in
which and the extent to which the proposed changes will improve
services to or quality of care for clients in the waiver program;
(3) establish clear goals to be achieved through the
proposed changes;
(4) establish a timeline for implementing the proposed
changes; and
(5) identify specific actions necessary to implement
the proposed changes.
(e) The commission may require that an amelioration plan
propose changes that would result in conditions that exceed the
requirements of a law or rule relating to the waiver program in
which the provider participates.
(f) The commission shall approve or deny an amelioration
plan not later than the 45th day after the date the commission
receives the plan. On approval of a provider's plan, the commission
or the State Office of Administrative Hearings, as appropriate,
shall deny a pending request for a hearing submitted by the
provider.
(g) The commission may not offer amelioration to a provider:
(1) more than three times in a two-year period; or
(2) more than one time in a two-year period for the
same or similar violation.
Sec. 161.0892. INFORMAL DISPUTE RESOLUTION. (a) The
executive commissioner by rule shall establish an informal dispute
resolution process in accordance with this section. The process
must provide for adjudication by an appropriate disinterested
person of disputes relating to a proposed enforcement action or
related proceeding of the commission against a provider
participating in a waiver program described by Section 161.089.
The informal dispute resolution process must require:
(1) a provider participating in a waiver program
described by Section 161.089 to request informal dispute resolution
not later than the 10th calendar day after the date of notification
by the commission of the violation of a law or rule relating to the
program; and
(2) the commission to complete the process not later
than the 30th calendar day after the date of receipt of a request
from a provider for informal dispute resolution.
(b) As part of the informal dispute resolution process
established under this section, the commission shall contract with
an appropriate disinterested person who is a nonprofit organization
to adjudicate disputes between a provider participating in a
program described by Section 161.089 and the commission concerning
a statement of violations prepared by the commission. Section
2009.053, Government Code, does not apply to the selection of an
appropriate disinterested person under this subsection. The person
with whom the commission contracts shall adjudicate all disputes
described by this subsection.
(c) The executive commissioner shall adopt rules to
adjudicate claims in contested cases.
(d) The commission may not delegate its responsibility to
administer the informal dispute resolution process established by
this section to another state agency.
SECTION 2. Subchapter D, Chapter 161, Human Resources Code,
is amended by adding Sections 161.0881 and 161.0882 to read as
follows:
Sec. 161.0881. AMELIORATION PROCESS. (a) In lieu of
demanding payment of an administrative penalty assessed under
Section 161.088, the commission may, in accordance with this
section, allow the provider subject to the penalty to use, under the
supervision of the commission, any portion of the amount of the
penalty to ameliorate the violation or to improve services in the
waiver program in which the provider participates.
(b) The commission shall offer amelioration to a provider
under this section not later than the 10th day after the date the
provider receives from the commission a final notification of the
assessment of an administrative penalty that is sent to the
provider after an informal dispute resolution process but before an
administrative hearing.
(c) A provider to whom amelioration has been offered must
file a plan for amelioration not later than the 45th day after the
date the provider receives the offer of amelioration from the
commission. In submitting the plan, the provider must agree to
waive the provider's right to an administrative hearing if the
commission approves the plan.
(d) At a minimum, a plan for amelioration must:
(1) propose changes to the management or operation of
the waiver program in which the provider participates that will
improve services to or quality of care for clients in the program;
(2) identify, through measurable outcomes, the ways in
which and the extent to which the proposed changes will improve
services to or quality of care for clients in the waiver program;
(3) establish clear goals to be achieved through the
proposed changes;
(4) establish a timeline for implementing the proposed
changes; and
(5) identify specific actions necessary to implement
the proposed changes.
(e) The commission may require that an amelioration plan
propose changes that would result in conditions that exceed the
requirements of a law or rule relating to the waiver program in
which the provider participates.
(f) The commission shall approve or deny an amelioration
plan not later than the 45th day after the date the commission
receives the plan. On approval of a provider's plan, the commission
or the State Office of Administrative Hearings, as appropriate,
shall deny a pending request for a hearing submitted by the
provider.
(g) The commission may not offer amelioration to a provider:
(1) more than three times in a two-year period; or
(2) more than one time in a two-year period for the
same or similar violation.
Sec. 161.0882. INFORMAL DISPUTE RESOLUTION. (a) The
executive commissioner by rule shall establish an informal dispute
resolution process in accordance with this section. The process
must provide for adjudication by an appropriate disinterested
person of disputes relating to a proposed enforcement action or
related proceeding of the commission against a provider
participating in a waiver program described by Section 161.088.
The informal dispute resolution process must require:
(1) a provider participating in a waiver program
described by Section 161.088 to request informal dispute resolution
not later than the 10th calendar day after the date of notification
by the commission of the violation of a law or rule relating to the
program; and
(2) the commission to complete the process not later
than the 30th calendar day after the date of receipt of a request
from a provider for informal dispute resolution.
(b) As part of the informal dispute resolution process
established under this section, the commission shall contract with
an appropriate disinterested person who is a nonprofit organization
to adjudicate disputes between a provider participating in a
program described by Section 161.088 and the commission concerning
a statement of violations prepared by the commission. Section
2009.053, Government Code, does not apply to the selection of an
appropriate disinterested person under this subsection. The person
with whom the commission contracts shall adjudicate all disputes
described by this subsection.
(c) The executive commissioner shall adopt rules to
adjudicate claims in contested cases.
(d) The commission may not delegate its responsibility to
administer the informal dispute resolution process established by
this section to another state agency.
SECTION 3. (a) Section 1 of this Act takes effect only if
the Act of the 85th Legislature, Regular Session, 2017, relating to
nonsubstantive additions to and corrections in enacted codes
becomes law.
(b) Section 2 of this Act takes effect only if the Act of the
85th Legislature, Regular Session, 2017, relating to
nonsubstantive additions to and corrections in enacted codes does
not become law.
SECTION 4. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall adopt the rules necessary to implement
the changes in law made by this Act.
SECTION 5. This Act takes effect September 1, 2017.