85R9622 LED-D
By: Longoria H.B. No. 4115
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of a home and community support
services improvement pilot program under the Medicaid managed care
program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 533, Government Code, is amended by
adding Subchapter F to read as follows:
SUBCHAPTER F. HOME AND COMMUNITY SUPPORT SERVICES IMPROVEMENT
PILOT PROGRAM
Sec. 533.101. DEFINITIONS. In this subchapter:
(1) "Electronic visit verification device" means a
device that is installed in an individual's residence and is used by
a provider agency to verify that a personal care attendant arrives
at the individual's residence to provide services.
(2) "Health service region" means a public health
region designated under Section 121.007, Health and Safety Code.
(3) "Participating provider agency" means a provider
agency participating in the pilot program established under this
subchapter.
(4) "Personal care attendant" means an individual
employed by a provider agency to provide personal care services.
The term does not include an individual described by Section
142.003(a)(1) or (2), Health and Safety Code.
(5) "Personal care services" means nonmedical
services that enable an individual to engage in the activities of
daily living or to perform the physical functions required for
independent living, including:
(A) bathing, dressing, grooming, feeding,
exercising, toileting, positioning, assisting with
self-administered medications, routine hair and skin care, and
transfer or ambulation; and
(B) light housekeeping, grocery shopping, meal
preparation, and laundry.
(6) "Pilot program" means the program established
under this subchapter.
(7) "Provider agency" means an agency that contracts
with a managed care organization that contracts with the commission
to provide health care services to recipients for the provision of
personal care services by the agency. The term includes a home and
community support services agency licensed under Chapter 142,
Health and Safety Code, and a continuing care facility licensed
under Chapter 246, Health and Safety Code.
Sec. 533.102. PILOT PROGRAM. (a) The commission shall
establish a pilot program in the health service region designated
as Region 11 to:
(1) improve the delivery of home and community support
services by provider agencies under the Medicaid managed care
program;
(2) reduce recipient rehospitalization and unplanned
doctor visits;
(3) achieve cost savings; and
(4) reduce fraud, abuse, and waste.
(b) The commission, with the assistance of interested
parties, including participating provider agencies, managed care
organizations, researchers, and persons who provide funding for the
program, shall develop the pilot program. The program must:
(1) provide services to at least 15,000 and not more
than 20,000 recipients by its final year of operation; and
(2) include the components described by this
subchapter.
(c) The commission shall contract with an independent or
university-based health research organization, such as a
university group, to assist with the pilot program, by conducting
research for and evaluating the effectiveness of the program. The
research organization may:
(1) determine data that will be reported and
performance measures that will be used under the program;
(2) provide feedback throughout the operation of the
program to adjust data reporting;
(3) evaluate the relationship between changes
implemented by the program and recipient health outcomes;
(4) compare recipient health outcomes with those of
recipients not receiving services in the program; and
(5) prepare a final report that analyzes the
effectiveness of the program and makes recommendations about
whether to continue the program or any part of the program.
Sec. 533.103. PERSONAL CARE ATTENDANT TRAINING. The
commission, in consultation with participating provider agencies
and a local community college or health care training organization,
shall develop as a component of the pilot program a training program
for personal care attendants. The program's curriculum must focus
on helping a personal care attendant avoid recipient
rehospitalization and must include instruction about:
(1) recognition of potential adverse health care
conditions;
(2) trip and fall avoidance;
(3) basic nutrition and cooking;
(4) medication prompting; and
(5) mobility and activity enhancement.
Sec. 533.104. INCREASED SUPERVISION AND COMPLIANCE. As a
component of the pilot program, the commission shall require a
participating provider agency to:
(1) increase supervision of the agency's personal care
attendants;
(2) implement stricter compliance protocols for
attendants; and
(3) at least quarterly conduct scheduled and
unscheduled visits to a recipient's home to confer with the
recipient about the personal care services the recipient is
receiving.
Sec. 533.105. FRAUD, WASTE, AND ABUSE PREVENTION PROTOCOLS.
As a component of the pilot program, the commission shall require a
participating provider agency to:
(1) develop enhanced fraud, waste, and abuse
prevention protocols that address collusion and fraud among
recipients, personal care attendants, and other provider agency
staff; and
(2) implement the protocols during a recipient's
enrollment, an agency's hiring process and employment reviews, and
other critical points in the delivery of personal care services.
Sec. 533.106. PERSONAL CARE ATTENDANT REGISTRY. The
commission, in consultation with participating provider agencies
and managed care organizations that contract with the commission to
provide health care services to recipients, shall establish as a
component of the pilot program a personal care attendant registry
that allows the commission to:
(1) track personal care attendant performance by
measuring recipient health outcomes; and
(2) identify each personal care attendant who fails to
meet certain standards, including following a participating
provider agency's implementation of progressive work improvement
efforts for the attendant.
Sec. 533.107. RECIPIENT TRANSFER PROTOCOLS. (a) As a
component of the pilot program, the commission shall require a
participating provider agency to develop and implement enhanced
recipient transfer protocols to:
(1) prevent a recipient and personal care attendant
from moving to a different provider agency in an effort to avoid
disciplinary action against or unfairly leverage a raise for the
personal care attendant;
(2) prevent fraud, waste, and abuse; and
(3) identify a poorly performing personal care
attendant.
(b) An enhanced recipient transfer protocol developed under
this section must allow a recipient to choose a provider agency.
Sec. 533.108. ENHANCED ELECTRONIC VISIT VERIFICATION
DEVICE COMPLIANCE. (a) As a component of the pilot program, the
commission shall require a participating provider agency to develop
and implement enhanced electronic visit verification device
compliance protocols to prevent fraud and waste due to an
attendant's reporting of hours that the attendant did not work.
(b) The commission shall meet with developers or providers
of electronic visit verification devices used by provider agencies
to explore additional options to counter fraud using the systems.
Sec. 533.109. ANTI-SOLICITATION AND ANTI-KICKBACK RULES.
The commission, in consultation with participating provider
agencies, shall determine as a component of the pilot program
strategies to strengthen anti-solicitation and anti-kickback rules
in order to prevent fraud and waste and improve the continuity of
care for recipients.
Sec. 533.110. ENHANCED PROVIDER AGENCY STANDARDS. The
commission, in consultation with participating provider agencies,
shall develop as a component of the pilot program stricter provider
agency standards to continually improve the delivery of home and
community support services. The standards must be outcome-based
and measured by recipient health outcomes or satisfaction.
Sec. 533.111. INCREASED ENFORCEMENT. (a) The commission,
in consultation with the commission's office of inspector general
and participating provider agencies, shall develop and implement:
(1) strengthened enforcement strategies for the pilot
program components; and
(2) effective strategies for provider agency
self-regulation with respect to the pilot program components and
other applicable requirements.
(b) The strategies must focus on:
(1) preventing fraud, waste, and abuse;
(2) eliminating from the Medicaid managed care program
the provider agencies and personal care attendants who have the
poorest performance;
(3) improving health care outcomes for recipients; and
(4) increasing savings for the state.
Sec. 533.112. MANAGED CARE ORGANIZATION PARTNERSHIPS. The
commission shall coordinate as a component of the pilot program
partnerships between participating provider agencies and managed
care organizations that contract with the commission to provide
health care services to recipients to improve the delivery of home
and community support services under the Medicaid managed care
program.
Sec. 533.113. REPORT. (a) Not later than September 1,
2021, the commission shall submit to the legislature a report
concerning the pilot program that includes:
(1) the results of any research related to the
program;
(2) the effectiveness of each component of the
program;
(3) any reports made by a participant or research
organization during the course of the program;
(4) other relevant information concerning the
program; and
(5) a recommendation about whether the pilot program
should be continued in whole or in part, expanded, or terminated.
(b) The commission shall provide the report prepared under
Subsection (a) to participating provider agencies and managed care
organizations.
Sec. 533.114. GIFTS, GRANTS, AND DONATIONS. The commission
may solicit and accept gifts, grants, and donations of any kind and
from any source for purposes of implementing this subchapter.
Sec. 533.115. RULES. The executive commissioner may adopt
rules necessary to implement this subchapter.
Sec. 533.116. EXPIRATION. This subchapter expires
September 1, 2023.
SECTION 2. Not later than January 1, 2018, the Health and
Human Services Commission shall establish the home and community
support services improvement pilot program as required by
Subchapter F, Chapter 533, Government Code, as added by 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 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, 2017.