Texas 2017 - 85th Regular

Texas House Bill HB3520 Compare Versions

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1	1	By: Davis of Harris H.B. No. 3520
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to state fiscal matters related to health and human
7	7	services and state agencies administering health and human services
8	8	programs.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	ARTICLE 1. REDUCTION OF EXPENDITURES AND IMPOSITION OF CHARGES AND
11	11	COST-SAVING MEASURES GENERALLY
12	12	SECTION 1.01. This article applies to any state agency that
13	13	receives an appropriation under Article II of the General
14	14	Appropriations Act and to any program administered by any of those
15	15	agencies.
16	16	SECTION 1.02. Notwithstanding any other statute of this
17	17	state, each state agency to which this article applies is
18	18	authorized to reduce or recover expenditures by:
19	19	(1) consolidating any reports or publications the
20	20	agency is required to make and filing or delivering any of those
21	21	reports or publications exclusively by electronic means;
22	22	(2) extending the effective period of any license,
23	23	permit, or registration the agency grants or administers;
24	24	(3) entering into a contract with another governmental
25	25	entity or with a private vendor to carry out any of the agency's
26	26	duties;
27	27	(4) adopting additional eligibility requirements
28	28	consistent with federal law for persons who receive benefits under
29	29	any law the agency administers to ensure that those benefits are
30	30	received by the most deserving persons consistent with the purposes
31	31	for which the benefits are provided, including under the following
32	32	laws:
33	33	(A) Chapter 62, Health and Safety Code (child
34	34	health plan program);
35	35	(B) Chapter 31, Human Resources Code (Temporary
36	36	Assistance for Needy Families program);
37	37	(C) Chapter 32, Human Resources Code (Medicaid
38	38	program);
39	39	(D) Chapter 33, Human Resources Code
40	40	(supplemental nutrition assistance and other nutritional
41	41	assistance programs); and
42	42	(E) Chapter 533, Government Code (Medicaid
43	43	managed care);
44	44	(5) providing that any communication between the
45	45	agency and another person and any document required to be delivered
46	46	to or by the agency, including any application, notice, billing
47	47	statement, receipt, or certificate, may be made or delivered by
48	48	e-mail or through the Internet;
49	49	(6) adopting and collecting fees or charges to cover
50	50	any costs the agency incurs in performing its lawful functions; and
51	51	(7) modifying and streamlining processes used in:
52	52	(A) the conduct of eligibility determinations
53	53	for programs listed in Subdivision (4) of this subsection by or
54	54	under the direction of the Health and Human Services Commission;
55	55	(B) the provision of child and adult protective
56	56	services by the Department of Family and Protective Services;
57	57	(C) the provision of community health services,
58	58	consumer protection services, and mental health services by the
59	59	Department of State Health Services; and
60	60	(D) the provision or administration of other
61	61	services provided or programs operated by the Health and Human
62	62	Services Commission or a health and human services agency, as
63	63	defined by Section 531.001, Government Code.
64	64	ARTICLE 2. MEDICAID PROGRAM
65	65	SECTION 2.01. Subchapter A, Chapter 533, Government Code,
66	66	is amended by adding Sections 533.00291, 533.00292, and 533.00293
67	67	to read as follows:
68	68	Sec. 533.00291. CARE COORDINATION BENEFITS. (a) In this
69	69	section, "care coordination" means assisting recipients to develop
70	70	a plan of care, including a service plan, that meets the recipient's
71	71	needs and coordinating the provision of Medicaid benefits in a
72	72	manner that is consistent with the plan of care. The term is
73	73	synonymous with "case management," "service coordination," and
74	74	"service management."
75	75	(b) The commission shall streamline and clarify the
76	76	provision of care coordination benefits across Medicaid programs
77	77	and services for recipients receiving benefits under a managed care
78	78	delivery model. In streamlining and clarifying the provision of
79	79	care coordination benefits under this section, the commission shall
80	80	at a minimum:
81	81	(1) subject to Subsection (c), establish a process for
82	82	determining and designating a single entity as the primary entity
83	83	responsible for a recipient's care coordination;
84	84	(2) evaluate and eliminate duplicative services
85	85	intended to achieve recipient care coordination, including care
86	86	coordination or related benefits provided:
87	87	(A) by a Medicaid managed care organization;
88	88	(B) by a recipient's medical or health home;
89	89	(C) through a disease management program
90	90	provided by a Medicaid managed care organization;
91	91	(D) by a provider of targeted case management and
92	92	psychiatric rehabilitation services; and
93	93	(E) through a program of case management for
94	94	high-risk pregnant women and high-risk children established under
95	95	Section 22.0031, Human Resources Code;
96	96	(3) evaluate and, if the commission determines it
97	97	appropriate, modify the capitation rate paid to Medicaid managed
98	98	care organizations to account for the provision of care
99	99	coordination benefits by a person not affiliated with the
100	100	organization; and
101	101	(4) establish and use a consistent set of terms for
102	102	care coordination provided under a managed care delivery model.
103	103	(c) In establishing a process under Subsection (b)(1), the
104	104	commission shall ensure that:
105	105	(1) for a recipient who receives targeted case
106	106	management and psychiatric rehabilitation services, the default
107	107	entity to act as the primary entity responsible for the recipient's
108	108	care coordination under Subsection (b)(1) is the provider of
109	109	targeted case management and psychiatric rehabilitation services;
110	110	and
111	111	(2) for recipients other than those described by
112	112	Subdivision (1), the process includes an evaluation process
113	113	designed to identify the provider that would best meet the care
114	114	coordination needs of a recipient and that the commission
115	115	incorporates into Medicaid managed care program contracts.
116	116	Sec. 533.00292. CARE COORDINATOR CASELOAD STANDARDS. (a)
117	117	In this section:
118	118	(1) "Care coordination" has the meaning assigned by
119	119	Section 533.00291.
120	120	(2) "Care coordinator" means a person, including a
121	121	case manager, engaged by a Medicaid managed care organization to
122	122	provide care coordination benefits.
123	123	(b) The executive commissioner by rule shall establish
124	124	caseload standards for care coordinators providing care
125	125	coordination under the STAR+PLUS home and community-based services
126	126	supports (HCBS) program.
127	127	(c) The executive commissioner by rule may, if the executive
128	128	commissioner determines it appropriate, establish caseload
129	129	standards for care coordinators providing care coordination under
130	130	Medicaid programs other than the STAR+PLUS home and community-based
131	131	services supports (HCBS) program.
132	132	(d) In determining whether to establish caseload standards
133	133	for a Medicaid program under Subsection (c), the executive
134	134	commissioner shall consider whether implementing the standards
135	135	would improve:
136	136	(1) Medicaid managed care organization contract
137	137	compliance;
138	138	(2) the quality of care coordination provided under
139	139	the program;
140	140	(3) recipient health outcomes; and
141	141	(4) transparency regarding the availability of care
142	142	coordination benefits to recipients and interested stakeholders.
143	143	Sec. 533.00293. INFORMATION SHARING. (a) In this section:
144	144	(1) "Care coordination" has the meaning assigned by
145	145	Section 533.00291.
146	146	(2) "Care coordinator" has the meaning assigned by
147	147	Section 533.00292.
148	148	(b) To the extent permitted under applicable federal and
149	149	state law enacted to protect the confidentiality and privacy of
150	150	patients' health information, managed care organizations under
151	151	contract with the commission to provide health care services to
152	152	recipients shall ensure the sharing of information, including
153	153	recipient medical records, among care coordinators and health care
154	154	providers as appropriate to provide care coordination benefits.
155	155	For purposes of implementing this section, a managed care
156	156	organization may allow a care coordinator to share a recipient's
157	157	service plan with health care providers, subject to the limitations
158	158	of this section.
159	159	SECTION 2.02. Section 533.0061, Government Code, as added
160	160	by Chapter 1272 (S.B. 760), Acts of the 84th Legislature, Regular
161	161	Session, 2015, is amended by amending Subsections (a) and (c) and
162	162	adding Subsection (d) to read as follows:
163	163	(a) The commission shall establish minimum provider access
164	164	standards for the provider network of a managed care organization
165	165	that contracts with the commission to provide health care services
166	166	to recipients. The access standards must ensure that a managed
167	167	care organization provides recipients sufficient access to:
168	168	(1) preventive care;
169	169	(2) primary care;
170	170	(3) specialty care;
171	171	(4) [after-hours] urgent care;
172	172	(5) chronic care;
173	173	(6) long-term services and supports;
174	174	(7) nursing services;
175	175	(8) therapy services, including services provided in a
176	176	clinical setting or in a home or community-based setting; and
177	177	(9) any other services identified by the commission.
178	178	(c) The commission shall biennially submit to the
179	179	legislature and make available to the public a report containing
180	180	information and statistics about recipient access to providers
181	181	through the provider networks of the managed care organizations and
182	182	managed care organization compliance with contractual obligations
183	183	related to provider access standards established under this
184	184	section. The report must contain:
185	185	(1) a compilation and analysis of information
186	186	submitted to the commission under Section 533.005(a)(20)(D);
187	187	(2) for both primary care providers and specialty
188	188	providers, information on provider-to-recipient ratios in an
189	189	organization's provider network, as well as benchmark ratios to
190	190	indicate whether deficiencies exist in a given network; [and]
191	191	(3) a description of, and analysis of the results
192	192	from, the commission's monitoring process established under
193	193	Section 533.007(l); and
194	194	(4) a detailed analysis of recipient access to urgent
195	195	care providers, including:
196	196	(A) an analysis of the implementation of any
197	197	distance standard adopted under Section 32.0248(b)(1), Human
198	198	Resources Code;
199	199	(B) information on urgent care
200	200	provider-to-recipient ratios; and
201	201	(C) information and statistics about
202	202	organization compliance with contractual obligations related to
203	203	urgent care access standards, including standards established
204	204	under Section 32.0248, Human Resources Code, and any other
205	205	applicable standards.
206	206	(d) In this section, "urgent care provider" has the meaning
207	207	assigned by Section 32.0248, Human Resources Code.
208	208	SECTION 2.03. Subchapter B, Chapter 32, Human Resources
209	209	Code, is amended by adding Section 32.0248 to read as follows:
210	210	Sec. 32.0248. INCREASING ACCESS TO URGENT CARE PROVIDERS.
211	211	(a) In this section, "urgent care provider" means a health care
212	212	provider that:
213	213	(1) provides episodic ambulatory medical care to
214	214	individuals outside of a hospital emergency room setting;
215	215	(2) does not require an individual to make an
216	216	appointment;
217	217	(3) provides some services typically provided in a
218	218	primary care physician's office; and
219	219	(4) treats individuals requiring treatment of an
220	220	illness or injury that requires immediate care but is not
221	221	life-threatening.
222	222	(b) The executive commissioner shall adopt rules and
223	223	policies to increase recipient access to urgent care providers
224	224	under the medical assistance program. In adopting the rules and
225	225	policies under this subsection, the executive commissioner shall
226	226	consider:
227	227	(1) whether to establish a distance standard to ensure
228	228	that all recipients have access to at least one urgent care provider
229	229	within a specified distance of the recipient's residence;
230	230	(2) requiring that the medical assistance program
231	231	provider database established under Section 32.102 accurately
232	232	identify urgent care providers;
233	233	(3) requiring each managed care organization that
234	234	contracts with the commission under Chapter 533, Government Code,
235	235	to provide health care services to medical assistance recipients
236	236	to:
237	237	(A) improve the accuracy and accessibility of
238	238	information regarding urgent care providers in the managed care
239	239	organization's provider network directory required under Section
240	240	533.0063, Government Code; and
241	241	(B) if the organization maintains a nurse
242	242	telephone hotline for its enrolled recipients, provide information
243	243	to recipients, if appropriate, on the availability of services
244	244	through in-network urgent care providers; and
245	245	(4) encouraging primary care physicians participating
246	246	in the medical assistance program to maintain a relationship with
247	247	urgent care providers for purposes of referring recipients in need
248	248	of urgent care.
249	249	(c) In addition to adopting rules and policies under
250	250	Subsection (b), to increase medical assistance recipients' access
251	251	to urgent care providers, the commission shall consider whether to
252	252	amend the Medicaid state plan to permit urgent care providers to
253	253	enroll as facility providers under the medical assistance program.
254	254	(d) The commission shall consider implementing a process to
255	255	streamline provider enrollment and credentialing for urgent care
256	256	providers, including applying the requirements of Sections
257	257	533.0055 and 533.0064, Government Code, to those providers.
258	258	SECTION 2.04. As soon as practicable after the effective
259	259	date of this article, the executive commissioner of the Health and
260	260	Human Services Commission shall adopt the rules required by Section
261	261	32.0248, Human Resources Code, as added by this article.
262	262	SECTION 2.05. This article takes effect immediately if this
263	263	Act receives a vote of two-thirds of all the members elected to each
264	264	house, as provided by Section 39, Article III, Texas Constitution.
265	265	If this Act does not receive the vote necessary for this article to
266	266	have immediate effect, this article takes effect September 1, 2017.
267	267	ARTICLE 3. MENTAL HEALTH SERVICES
268	268	SECTION 3.01. Subchapter B, Chapter 531, Government Code,
269	269	is amended by adding Section 531.0993 to read as follows:
270	270	Sec. 531.0993. GRANT PROGRAM TO REDUCE RECIDIVISM, ARREST,
271	271	AND INCARCERATION AMONG INDIVIDUALS WITH MENTAL ILLNESS AND TO
272	272	REDUCE WAIT TIME FOR FORENSIC COMMITMENT. (a) For purposes of this
273	273	section, "low-income household" means a household with a total
274	274	income at or below 200 percent of the federal poverty guideline.
275	275	(b) Using money appropriated to the commission for that
276	276	purpose, the commission shall make grants to county-based community
277	277	collaboratives for the purposes of reducing:
278	278	(1) recidivism by, the frequency of arrests of, and
279	279	incarceration of persons with mental illness; and
280	280	(2) the total waiting time for forensic commitment of
281	281	persons with mental illness to a state hospital.
282	282	(c) A community collaborative is eligible to receive a grant
283	283	under this section only if the collaborative includes a county, a
284	284	local mental health authority that operates in the county, and each
285	285	hospital district, if any, located in the county. A community
286	286	collaborative may include other local entities designated by the
287	287	collaborative's members.
288	288	(d) The commission shall condition each grant provided to a
289	289	community collaborative under this section on the collaborative
290	290	providing matching funds from non-state sources in a total amount
291	291	at least equal to the awarded grant amount. To raise matching
292	292	funds, a collaborative may seek and receive gifts, grants, or
293	293	donations from any person.
294	294	(e) The commission shall estimate the number of cases of
295	295	serious mental illness in low-income households located in each of
296	296	the 10 most populous counties in this state. For the purposes of
297	297	distributing grants under this section to community collaboratives
298	298	established in those 10 counties, for each fiscal year the
299	299	commission shall determine an amount of grant money available on a
300	300	per-case basis by dividing the total amount of money appropriated
301	301	to the commission for the purpose of making grants under this
302	302	section in that year by the estimated total number of cases of
303	303	serious mental illness in low-income households located in those 10
304	304	counties.
305	305	(f) The commission shall make available to a community
306	306	collaborative established in each of the 10 most populous counties
307	307	in this state a grant in an amount equal to the lesser of:
308	308	(1) an amount determined by multiplying the per-case
309	309	amount determined under Subsection (e) by the estimated number of
310	310	cases of serious mental illness in low-income households in that
311	311	county; or
312	312	(2) an amount equal to the collaborative's available
313	313	matching funds.
314	314	(g) To the extent appropriated money remains available to
315	315	the commission for that purpose after the commission awards grants
316	316	under Subsection (f), the commission shall make available to
317	317	community collaboratives established in other counties in this
318	318	state grants through a competitive request for proposal process.
319	319	For purposes of awarding a grant under this subsection, a
320	320	collaborative may include adjacent counties if, for each member
321	321	county, the collaborative's members include a local mental health
322	322	authority that operates in the county and each hospital district,
323	323	if any, located in the county. A grant awarded under this
324	324	subsection may not exceed an amount equal to the lesser of:
325	325	(1) an amount determined by multiplying the per-case
326	326	amount determined under Subsection (e) by the estimated number of
327	327	cases of serious mental illness in low-income households in the
328	328	county or counties; or
329	329	(2) an amount equal to the collaborative's available
330	330	matching funds.
331	331	(h) The community collaboratives established in each of the
332	332	10 most populous counties in this state shall submit to the
333	333	commission a plan that:
334	334	(1) is endorsed by each of the collaborative's member
335	335	entities;
336	336	(2) identifies a target population;
337	337	(3) describes how the grant money and matching funds
338	338	will be used;
339	339	(4) includes outcome measures to evaluate the success
340	340	of the plan, including the plan's effect on reducing state hospital
341	341	admissions of the target population; and
342	342	(5) describes how the success of the plan in
343	343	accordance with the outcome measures would further the state's
344	344	interest in the grant program's purposes.
345	345	(i) A community collaborative that applies for a grant under
346	346	Subsection (g) must submit to the commission a plan as described by
347	347	Subsection (h). The commission shall consider the submitted plan
348	348	together with any other relevant information in awarding a grant
349	349	under Subsection (g).
350	350	(j) The commission must review and approve plans submitted
351	351	under Subsection (h) or (i) before the commission distributes a
352	352	grant under Subsection (f) or (g). If the commission determines
353	353	that a plan includes insufficient outcome measures, the commission
354	354	may make the necessary changes to the plan to establish appropriate
355	355	outcome measures. The commission may not make other changes to a
356	356	plan submitted under Subsection (h) or (i).
357	357	(k) Acceptable uses for the grant money and matching funds
358	358	include:
359	359	(1) the continuation of a mental health jail diversion
360	360	program;
361	361	(2) the establishment or expansion of a mental health
362	362	jail diversion program;
363	363	(3) the establishment of alternatives to competency
364	364	restoration in a state hospital, including outpatient competency
365	365	restoration, inpatient competency restoration in a setting other
366	366	than a state hospital, or jail-based competency restoration;
367	367	(4) the provision of assertive community treatment or
368	368	forensic assertive community treatment with an outreach component;
369	369	(5) the provision of intensive mental health services
370	370	and substance abuse treatment not readily available in the county;
371	371	(6) the provision of continuity of care services for
372	372	an individual being released from a state hospital;
373	373	(7) the establishment of interdisciplinary rapid
374	374	response teams to reduce law enforcement's involvement with mental
375	375	health emergencies; and
376	376	(8) the provision of local community hospital, crisis,
377	377	respite, or residential beds.
378	378	(l) Not later than December 31 of each year for which the
379	379	commission distributes a grant under this section, each community
380	380	collaborative that receives a grant shall prepare and submit a
381	381	report describing the effect of the grant money and matching funds
382	382	in achieving the standard defined by the outcome measures in the
383	383	plan submitted under Subsection (h) or (i).
384	384	(m) The commission may make inspections of the operation and
385	385	provision of mental health services provided by a community
386	386	collaborative to ensure state money appropriated for the grant
387	387	program is used effectively.
388	388	(n) The commission shall enter into an agreement with a
389	389	qualified nonprofit or private entity to serve as the administrator
390	390	of the grant program at no cost to the state. The administrator
391	391	shall assist, support, and advise the commission in fulfilling the
392	392	commission's responsibilities with respect to the grant program.
393	393	The administrator may advise the commission on:
394	394	(1) design, development, implementation, and
395	395	management of the program;
396	396	(2) eligibility requirements for grant recipients;
397	397	(3) design and management of the competitive bidding
398	398	processes for applications or proposals and the evaluation and
399	399	selection of grant recipients;
400	400	(4) grant requirements and mechanisms;
401	401	(5) roles and responsibilities of grant recipients;
402	402	(6) reporting requirements for grant recipients;
403	403	(7) support and technical capabilities;
404	404	(8) timelines and deadlines for the program;
405	405	(9) evaluation of the program and grant recipients;
406	406	(10) requirements for reporting on the program to
407	407	policy makers; and
408	408	(11) estimation of the number of cases of serious
409	409	mental illness in low-income households in each county.
410	410	ARTICLE 4. CHILD PROTECTIVE AND PREVENTION AND EARLY INTERVENTION
411	411	SERVICES
412	412	SECTION 4.01. Subchapter A, Chapter 261, Family Code, is
413	413	amended by adding Section 261.004 to read as follows:
414	414	Sec. 261.004. TRACKING OF RECURRENCE OF CHILD ABUSE OR
415	415	NEGLECT REPORTS. The department shall collect, compile, and
416	416	monitor data regarding repeated reports of abuse or neglect
417	417	involving the same child or by the same alleged perpetrator. In
418	418	compiling reports under this section, the department shall group
419	419	together separate reports involving different children residing in
420	420	the same household.
421	421	SECTION 4.02. Subchapter A, Chapter 265, Family Code, is
422	422	amended by adding Sections 265.0041 and 265.0042 to read as
423	423	follows:
424	424	Sec. 265.0041. GEOGRAPHIC RISK MAPPING FOR PREVENTION AND
425	425	EARLY INTERVENTION SERVICES. (a) The department shall use
426	426	existing risk terrain modeling systems, predictive analytics, or
427	427	geographic risk assessments to:
428	428	(1) identify geographic areas that have high risk
429	429	indicators of child maltreatment and child fatalities resulting
430	430	from abuse or neglect; and
431	431	(2) target the implementation and use of prevention
432	432	and early intervention services to those geographic areas.
433	433	(b) The department may not use data gathered under this
434	434	section to identify a specific family or individual.
435	435	Sec. 265.0042. COLLABORATION WITH INSTITUTIONS OF HIGHER
436	436	EDUCATION. (a) The Health and Human Services Commission, on behalf
437	437	of the department, shall enter into agreements with institutions of
438	438	higher education to conduct efficacy reviews of any prevention and
439	439	early intervention programs that have not previously been evaluated
440	440	for effectiveness through a scientific research evaluation
441	441	process.
442	442	(b) The department shall collaborate with an institution of
443	443	higher education to create and track indicators of child well-being
444	444	to determine the effectiveness of prevention and early intervention
445	445	services.
446	446	SECTION 4.03. Section 265.005(b), Family Code, is amended
447	447	to read as follows:
448	448	(b) A strategic plan required under this section must:
449	449	(1) identify methods to leverage other sources of
450	450	funding or provide support for existing community-based prevention
451	451	efforts;
452	452	(2) include a needs assessment that identifies
453	453	programs to best target the needs of the highest risk populations
454	454	and geographic areas;
455	455	(3) identify the goals and priorities for the
456	456	department's overall prevention efforts;
457	457	(4) report the results of previous prevention efforts
458	458	using available information in the plan;
459	459	(5) identify additional methods of measuring program
460	460	effectiveness and results or outcomes;
461	461	(6) identify methods to collaborate with other state
462	462	agencies on prevention efforts; [and]
463	463	(7) identify specific strategies to implement the plan
464	464	and to develop measures for reporting on the overall progress
465	465	toward the plan's goals; and
466	466	(8) identify specific strategies to increase local
467	467	capacity for the delivery of prevention and early intervention
468	468	services through collaboration with communities and stakeholders.
469	469	ARTICLE 5. FEDERAL AUTHORIZATION; EFFECTIVE DATE
470	470	SECTION 5.01. If before implementing any provision of this
471	471	Act a state agency determines that a waiver or authorization from a
472	472	federal agency is necessary for implementation of that provision,
473	473	the agency affected by the provision shall request the waiver or
474	474	authorization and may delay implementing that provision until the
475	475	waiver or authorization is granted.
476	476	SECTION 5.02. Except as otherwise provided by this Act,
477	477	this Act takes effect September 1, 2017.