By: Davis of Harris H.B. No. 3520
A BILL TO BE ENTITLED
AN ACT
relating to state fiscal matters related to health and human
services and state agencies administering health and human services
programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. REDUCTION OF EXPENDITURES AND IMPOSITION OF CHARGES AND
COST-SAVING MEASURES GENERALLY
SECTION 1.01. This article applies to any state agency that
receives an appropriation under Article II of the General
Appropriations Act and to any program administered by any of those
agencies.
SECTION 1.02. Notwithstanding any other statute of this
state, each state agency to which this article applies is
authorized to reduce or recover expenditures by:
(1) consolidating any reports or publications the
agency is required to make and filing or delivering any of those
reports or publications exclusively by electronic means;
(2) extending the effective period of any license,
permit, or registration the agency grants or administers;
(3) entering into a contract with another governmental
entity or with a private vendor to carry out any of the agency's
duties;
(4) adopting additional eligibility requirements
consistent with federal law for persons who receive benefits under
any law the agency administers to ensure that those benefits are
received by the most deserving persons consistent with the purposes
for which the benefits are provided, including under the following
laws:
(A) Chapter 62, Health and Safety Code (child
health plan program);
(B) Chapter 31, Human Resources Code (Temporary
Assistance for Needy Families program);
(C) Chapter 32, Human Resources Code (Medicaid
program);
(D) Chapter 33, Human Resources Code
(supplemental nutrition assistance and other nutritional
assistance programs); and
(E) Chapter 533, Government Code (Medicaid
managed care);
(5) providing that any communication between the
agency and another person and any document required to be delivered
to or by the agency, including any application, notice, billing
statement, receipt, or certificate, may be made or delivered by
e-mail or through the Internet;
(6) adopting and collecting fees or charges to cover
any costs the agency incurs in performing its lawful functions; and
(7) modifying and streamlining processes used in:
(A) the conduct of eligibility determinations
for programs listed in Subdivision (4) of this subsection by or
under the direction of the Health and Human Services Commission;
(B) the provision of child and adult protective
services by the Department of Family and Protective Services;
(C) the provision of community health services,
consumer protection services, and mental health services by the
Department of State Health Services; and
(D) the provision or administration of other
services provided or programs operated by the Health and Human
Services Commission or a health and human services agency, as
defined by Section 531.001, Government Code.
ARTICLE 2. MEDICAID PROGRAM
SECTION 2.01. Subchapter A, Chapter 533, Government Code,
is amended by adding Sections 533.00291, 533.00292, and 533.00293
to read as follows:
Sec. 533.00291. CARE COORDINATION BENEFITS. (a) In this
section, "care coordination" means assisting recipients to develop
a plan of care, including a service plan, that meets the recipient's
needs and coordinating the provision of Medicaid benefits in a
manner that is consistent with the plan of care. The term is
synonymous with "case management," "service coordination," and
"service management."
(b) The commission shall streamline and clarify the
provision of care coordination benefits across Medicaid programs
and services for recipients receiving benefits under a managed care
delivery model. In streamlining and clarifying the provision of
care coordination benefits under this section, the commission shall
at a minimum:
(1) subject to Subsection (c), establish a process for
determining and designating a single entity as the primary entity
responsible for a recipient's care coordination;
(2) evaluate and eliminate duplicative services
intended to achieve recipient care coordination, including care
coordination or related benefits provided:
(A) by a Medicaid managed care organization;
(B) by a recipient's medical or health home;
(C) through a disease management program
provided by a Medicaid managed care organization;
(D) by a provider of targeted case management and
psychiatric rehabilitation services; and
(E) through a program of case management for
high-risk pregnant women and high-risk children established under
Section 22.0031, Human Resources Code;
(3) evaluate and, if the commission determines it
appropriate, modify the capitation rate paid to Medicaid managed
care organizations to account for the provision of care
coordination benefits by a person not affiliated with the
organization; and
(4) establish and use a consistent set of terms for
care coordination provided under a managed care delivery model.
(c) In establishing a process under Subsection (b)(1), the
commission shall ensure that:
(1) for a recipient who receives targeted case
management and psychiatric rehabilitation services, the default
entity to act as the primary entity responsible for the recipient's
care coordination under Subsection (b)(1) is the provider of
targeted case management and psychiatric rehabilitation services;
and
(2) for recipients other than those described by
Subdivision (1), the process includes an evaluation process
designed to identify the provider that would best meet the care
coordination needs of a recipient and that the commission
incorporates into Medicaid managed care program contracts.
Sec. 533.00292. CARE COORDINATOR CASELOAD STANDARDS. (a)
In this section:
(1) "Care coordination" has the meaning assigned by
Section 533.00291.
(2) "Care coordinator" means a person, including a
case manager, engaged by a Medicaid managed care organization to
provide care coordination benefits.
(b) The executive commissioner by rule shall establish
caseload standards for care coordinators providing care
coordination under the STAR+PLUS home and community-based services
supports (HCBS) program.
(c) The executive commissioner by rule may, if the executive
commissioner determines it appropriate, establish caseload
standards for care coordinators providing care coordination under
Medicaid programs other than the STAR+PLUS home and community-based
services supports (HCBS) program.
(d) In determining whether to establish caseload standards
for a Medicaid program under Subsection (c), the executive
commissioner shall consider whether implementing the standards
would improve:
(1) Medicaid managed care organization contract
compliance;
(2) the quality of care coordination provided under
the program;
(3) recipient health outcomes; and
(4) transparency regarding the availability of care
coordination benefits to recipients and interested stakeholders.
Sec. 533.00293. INFORMATION SHARING. (a) In this section:
(1) "Care coordination" has the meaning assigned by
Section 533.00291.
(2) "Care coordinator" has the meaning assigned by
Section 533.00292.
(b) To the extent permitted under applicable federal and
state law enacted to protect the confidentiality and privacy of
patients' health information, managed care organizations under
contract with the commission to provide health care services to
recipients shall ensure the sharing of information, including
recipient medical records, among care coordinators and health care
providers as appropriate to provide care coordination benefits.
For purposes of implementing this section, a managed care
organization may allow a care coordinator to share a recipient's
service plan with health care providers, subject to the limitations
of this section.
SECTION 2.02. Section 533.0061, Government Code, as added
by Chapter 1272 (S.B. 760), Acts of the 84th Legislature, Regular
Session, 2015, is amended by amending Subsections (a) and (c) and
adding Subsection (d) to read as follows:
(a) The commission shall establish minimum provider access
standards for the provider network of a managed care organization
that contracts with the commission to provide health care services
to recipients. The access standards must ensure that a managed
care organization provides recipients sufficient access to:
(1) preventive care;
(2) primary care;
(3) specialty care;
(4) [after-hours] urgent care;
(5) chronic care;
(6) long-term services and supports;
(7) nursing services;
(8) therapy services, including services provided in a
clinical setting or in a home or community-based setting; and
(9) any other services identified by the commission.
(c) The commission shall biennially submit to the
legislature and make available to the public a report containing
information and statistics about recipient access to providers
through the provider networks of the managed care organizations and
managed care organization compliance with contractual obligations
related to provider access standards established under this
section. The report must contain:
(1) a compilation and analysis of information
submitted to the commission under Section 533.005(a)(20)(D);
(2) for both primary care providers and specialty
providers, information on provider-to-recipient ratios in an
organization's provider network, as well as benchmark ratios to
indicate whether deficiencies exist in a given network; [and]
(3) a description of, and analysis of the results
from, the commission's monitoring process established under
Section 533.007(l); and
(4) a detailed analysis of recipient access to urgent
care providers, including:
(A) an analysis of the implementation of any
distance standard adopted under Section 32.0248(b)(1), Human
Resources Code;
(B) information on urgent care
provider-to-recipient ratios; and
(C) information and statistics about
organization compliance with contractual obligations related to
urgent care access standards, including standards established
under Section 32.0248, Human Resources Code, and any other
applicable standards.
(d) In this section, "urgent care provider" has the meaning
assigned by Section 32.0248, Human Resources Code.
SECTION 2.03. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0248 to read as follows:
Sec. 32.0248. INCREASING ACCESS TO URGENT CARE PROVIDERS.
(a) In this section, "urgent care provider" means a health care
provider that:
(1) provides episodic ambulatory medical care to
individuals outside of a hospital emergency room setting;
(2) does not require an individual to make an
appointment;
(3) provides some services typically provided in a
primary care physician's office; and
(4) treats individuals requiring treatment of an
illness or injury that requires immediate care but is not
life-threatening.
(b) The executive commissioner shall adopt rules and
policies to increase recipient access to urgent care providers
under the medical assistance program. In adopting the rules and
policies under this subsection, the executive commissioner shall
consider:
(1) whether to establish a distance standard to ensure
that all recipients have access to at least one urgent care provider
within a specified distance of the recipient's residence;
(2) requiring that the medical assistance program
provider database established under Section 32.102 accurately
identify urgent care providers;
(3) requiring each managed care organization that
contracts with the commission under Chapter 533, Government Code,
to provide health care services to medical assistance recipients
to:
(A) improve the accuracy and accessibility of
information regarding urgent care providers in the managed care
organization's provider network directory required under Section
533.0063, Government Code; and
(B) if the organization maintains a nurse
telephone hotline for its enrolled recipients, provide information
to recipients, if appropriate, on the availability of services
through in-network urgent care providers; and
(4) encouraging primary care physicians participating
in the medical assistance program to maintain a relationship with
urgent care providers for purposes of referring recipients in need
of urgent care.
(c) In addition to adopting rules and policies under
Subsection (b), to increase medical assistance recipients' access
to urgent care providers, the commission shall consider whether to
amend the Medicaid state plan to permit urgent care providers to
enroll as facility providers under the medical assistance program.
(d) The commission shall consider implementing a process to
streamline provider enrollment and credentialing for urgent care
providers, including applying the requirements of Sections
533.0055 and 533.0064, Government Code, to those providers.
SECTION 2.04. As soon as practicable after the effective
date of this article, the executive commissioner of the Health and
Human Services Commission shall adopt the rules required by Section
32.0248, Human Resources Code, as added by this article.
SECTION 2.05. This article takes effect immediately if this
Act 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 this article to
have immediate effect, this article takes effect September 1, 2017.
ARTICLE 3. MENTAL HEALTH SERVICES
SECTION 3.01. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.0993 to read as follows:
Sec. 531.0993. GRANT PROGRAM TO REDUCE RECIDIVISM, ARREST,
AND INCARCERATION AMONG INDIVIDUALS WITH MENTAL ILLNESS AND TO
REDUCE WAIT TIME FOR FORENSIC COMMITMENT. (a) For purposes of this
section, "low-income household" means a household with a total
income at or below 200 percent of the federal poverty guideline.
(b) Using money appropriated to the commission for that
purpose, the commission shall make grants to county-based community
collaboratives for the purposes of reducing:
(1) recidivism by, the frequency of arrests of, and
incarceration of persons with mental illness; and
(2) the total waiting time for forensic commitment of
persons with mental illness to a state hospital.
(c) A community collaborative is eligible to receive a grant
under this section only if the collaborative includes a county, a
local mental health authority that operates in the county, and each
hospital district, if any, located in the county. A community
collaborative may include other local entities designated by the
collaborative's members.
(d) The commission shall condition each grant provided to a
community collaborative under this section on the collaborative
providing matching funds from non-state sources in a total amount
at least equal to the awarded grant amount. To raise matching
funds, a collaborative may seek and receive gifts, grants, or
donations from any person.
(e) The commission shall estimate the number of cases of
serious mental illness in low-income households located in each of
the 10 most populous counties in this state. For the purposes of
distributing grants under this section to community collaboratives
established in those 10 counties, for each fiscal year the
commission shall determine an amount of grant money available on a
per-case basis by dividing the total amount of money appropriated
to the commission for the purpose of making grants under this
section in that year by the estimated total number of cases of
serious mental illness in low-income households located in those 10
counties.
(f) The commission shall make available to a community
collaborative established in each of the 10 most populous counties
in this state a grant in an amount equal to the lesser of:
(1) an amount determined by multiplying the per-case
amount determined under Subsection (e) by the estimated number of
cases of serious mental illness in low-income households in that
county; or
(2) an amount equal to the collaborative's available
matching funds.
(g) To the extent appropriated money remains available to
the commission for that purpose after the commission awards grants
under Subsection (f), the commission shall make available to
community collaboratives established in other counties in this
state grants through a competitive request for proposal process.
For purposes of awarding a grant under this subsection, a
collaborative may include adjacent counties if, for each member
county, the collaborative's members include a local mental health
authority that operates in the county and each hospital district,
if any, located in the county. A grant awarded under this
subsection may not exceed an amount equal to the lesser of:
(1) an amount determined by multiplying the per-case
amount determined under Subsection (e) by the estimated number of
cases of serious mental illness in low-income households in the
county or counties; or
(2) an amount equal to the collaborative's available
matching funds.
(h) The community collaboratives established in each of the
10 most populous counties in this state shall submit to the
commission a plan that:
(1) is endorsed by each of the collaborative's member
entities;
(2) identifies a target population;
(3) describes how the grant money and matching funds
will be used;
(4) includes outcome measures to evaluate the success
of the plan, including the plan's effect on reducing state hospital
admissions of the target population; and
(5) describes how the success of the plan in
accordance with the outcome measures would further the state's
interest in the grant program's purposes.
(i) A community collaborative that applies for a grant under
Subsection (g) must submit to the commission a plan as described by
Subsection (h). The commission shall consider the submitted plan
together with any other relevant information in awarding a grant
under Subsection (g).
(j) The commission must review and approve plans submitted
under Subsection (h) or (i) before the commission distributes a
grant under Subsection (f) or (g). If the commission determines
that a plan includes insufficient outcome measures, the commission
may make the necessary changes to the plan to establish appropriate
outcome measures. The commission may not make other changes to a
plan submitted under Subsection (h) or (i).
(k) Acceptable uses for the grant money and matching funds
include:
(1) the continuation of a mental health jail diversion
program;
(2) the establishment or expansion of a mental health
jail diversion program;
(3) the establishment of alternatives to competency
restoration in a state hospital, including outpatient competency
restoration, inpatient competency restoration in a setting other
than a state hospital, or jail-based competency restoration;
(4) the provision of assertive community treatment or
forensic assertive community treatment with an outreach component;
(5) the provision of intensive mental health services
and substance abuse treatment not readily available in the county;
(6) the provision of continuity of care services for
an individual being released from a state hospital;
(7) the establishment of interdisciplinary rapid
response teams to reduce law enforcement's involvement with mental
health emergencies; and
(8) the provision of local community hospital, crisis,
respite, or residential beds.
(l) Not later than December 31 of each year for which the
commission distributes a grant under this section, each community
collaborative that receives a grant shall prepare and submit a
report describing the effect of the grant money and matching funds
in achieving the standard defined by the outcome measures in the
plan submitted under Subsection (h) or (i).
(m) The commission may make inspections of the operation and
provision of mental health services provided by a community
collaborative to ensure state money appropriated for the grant
program is used effectively.
(n) The commission shall enter into an agreement with a
qualified nonprofit or private entity to serve as the administrator
of the grant program at no cost to the state. The administrator
shall assist, support, and advise the commission in fulfilling the
commission's responsibilities with respect to the grant program.
The administrator may advise the commission on:
(1) design, development, implementation, and
management of the program;
(2) eligibility requirements for grant recipients;
(3) design and management of the competitive bidding
processes for applications or proposals and the evaluation and
selection of grant recipients;
(4) grant requirements and mechanisms;
(5) roles and responsibilities of grant recipients;
(6) reporting requirements for grant recipients;
(7) support and technical capabilities;
(8) timelines and deadlines for the program;
(9) evaluation of the program and grant recipients;
(10) requirements for reporting on the program to
policy makers; and
(11) estimation of the number of cases of serious
mental illness in low-income households in each county.
ARTICLE 4. CHILD PROTECTIVE AND PREVENTION AND EARLY INTERVENTION
SERVICES
SECTION 4.01. Subchapter A, Chapter 261, Family Code, is
amended by adding Section 261.004 to read as follows:
Sec. 261.004. TRACKING OF RECURRENCE OF CHILD ABUSE OR
NEGLECT REPORTS. The department shall collect, compile, and
monitor data regarding repeated reports of abuse or neglect
involving the same child or by the same alleged perpetrator. In
compiling reports under this section, the department shall group
together separate reports involving different children residing in
the same household.
SECTION 4.02. Subchapter A, Chapter 265, Family Code, is
amended by adding Sections 265.0041 and 265.0042 to read as
follows:
Sec. 265.0041. GEOGRAPHIC RISK MAPPING FOR PREVENTION AND
EARLY INTERVENTION SERVICES. (a) The department shall use
existing risk terrain modeling systems, predictive analytics, or
geographic risk assessments to:
(1) identify geographic areas that have high risk
indicators of child maltreatment and child fatalities resulting
from abuse or neglect; and
(2) target the implementation and use of prevention
and early intervention services to those geographic areas.
(b) The department may not use data gathered under this
section to identify a specific family or individual.
Sec. 265.0042. COLLABORATION WITH INSTITUTIONS OF HIGHER
EDUCATION. (a) The Health and Human Services Commission, on behalf
of the department, shall enter into agreements with institutions of
higher education to conduct efficacy reviews of any prevention and
early intervention programs that have not previously been evaluated
for effectiveness through a scientific research evaluation
process.
(b) The department shall collaborate with an institution of
higher education to create and track indicators of child well-being
to determine the effectiveness of prevention and early intervention
services.
SECTION 4.03. Section 265.005(b), Family Code, is amended
to read as follows:
(b) A strategic plan required under this section must:
(1) identify methods to leverage other sources of
funding or provide support for existing community-based prevention
efforts;
(2) include a needs assessment that identifies
programs to best target the needs of the highest risk populations
and geographic areas;
(3) identify the goals and priorities for the
department's overall prevention efforts;
(4) report the results of previous prevention efforts
using available information in the plan;
(5) identify additional methods of measuring program
effectiveness and results or outcomes;
(6) identify methods to collaborate with other state
agencies on prevention efforts; [and]
(7) identify specific strategies to implement the plan
and to develop measures for reporting on the overall progress
toward the plan's goals; and
(8) identify specific strategies to increase local
capacity for the delivery of prevention and early intervention
services through collaboration with communities and stakeholders.
ARTICLE 5. FEDERAL AUTHORIZATION; EFFECTIVE DATE
SECTION 5.01. 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 5.02. Except as otherwise provided by this Act,
this Act takes effect September 1, 2017.