Texas 2017 - 85th Regular

Texas House Bill HB4115 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	85R9622 LED-D
2	2	By: Longoria H.B. No. 4115
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the establishment of a home and community support
8	8	services improvement pilot program under the Medicaid managed care
9	9	program.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Chapter 533, Government Code, is amended by
12	12	adding Subchapter F to read as follows:
13	13	SUBCHAPTER F. HOME AND COMMUNITY SUPPORT SERVICES IMPROVEMENT
14	14	PILOT PROGRAM
15	15	Sec. 533.101. DEFINITIONS. In this subchapter:
16	16	(1) "Electronic visit verification device" means a
17	17	device that is installed in an individual's residence and is used by
18	18	a provider agency to verify that a personal care attendant arrives
19	19	at the individual's residence to provide services.
20	20	(2) "Health service region" means a public health
21	21	region designated under Section 121.007, Health and Safety Code.
22	22	(3) "Participating provider agency" means a provider
23	23	agency participating in the pilot program established under this
24	24	subchapter.
25	25	(4) "Personal care attendant" means an individual
26	26	employed by a provider agency to provide personal care services.
27	27	The term does not include an individual described by Section
28	28	142.003(a)(1) or (2), Health and Safety Code.
29	29	(5) "Personal care services" means nonmedical
30	30	services that enable an individual to engage in the activities of
31	31	daily living or to perform the physical functions required for
32	32	independent living, including:
33	33	(A) bathing, dressing, grooming, feeding,
34	34	exercising, toileting, positioning, assisting with
35	35	self-administered medications, routine hair and skin care, and
36	36	transfer or ambulation; and
37	37	(B) light housekeeping, grocery shopping, meal
38	38	preparation, and laundry.
39	39	(6) "Pilot program" means the program established
40	40	under this subchapter.
41	41	(7) "Provider agency" means an agency that contracts
42	42	with a managed care organization that contracts with the commission
43	43	to provide health care services to recipients for the provision of
44	44	personal care services by the agency. The term includes a home and
45	45	community support services agency licensed under Chapter 142,
46	46	Health and Safety Code, and a continuing care facility licensed
47	47	under Chapter 246, Health and Safety Code.
48	48	Sec. 533.102. PILOT PROGRAM. (a) The commission shall
49	49	establish a pilot program in the health service region designated
50	50	as Region 11 to:
51	51	(1) improve the delivery of home and community support
52	52	services by provider agencies under the Medicaid managed care
53	53	program;
54	54	(2) reduce recipient rehospitalization and unplanned
55	55	doctor visits;
56	56	(3) achieve cost savings; and
57	57	(4) reduce fraud, abuse, and waste.
58	58	(b) The commission, with the assistance of interested
59	59	parties, including participating provider agencies, managed care
60	60	organizations, researchers, and persons who provide funding for the
61	61	program, shall develop the pilot program. The program must:
62	62	(1) provide services to at least 15,000 and not more
63	63	than 20,000 recipients by its final year of operation; and
64	64	(2) include the components described by this
65	65	subchapter.
66	66	(c) The commission shall contract with an independent or
67	67	university-based health research organization, such as a
68	68	university group, to assist with the pilot program, by conducting
69	69	research for and evaluating the effectiveness of the program. The
70	70	research organization may:
71	71	(1) determine data that will be reported and
72	72	performance measures that will be used under the program;
73	73	(2) provide feedback throughout the operation of the
74	74	program to adjust data reporting;
75	75	(3) evaluate the relationship between changes
76	76	implemented by the program and recipient health outcomes;
77	77	(4) compare recipient health outcomes with those of
78	78	recipients not receiving services in the program; and
79	79	(5) prepare a final report that analyzes the
80	80	effectiveness of the program and makes recommendations about
81	81	whether to continue the program or any part of the program.
82	82	Sec. 533.103. PERSONAL CARE ATTENDANT TRAINING. The
83	83	commission, in consultation with participating provider agencies
84	84	and a local community college or health care training organization,
85	85	shall develop as a component of the pilot program a training program
86	86	for personal care attendants. The program's curriculum must focus
87	87	on helping a personal care attendant avoid recipient
88	88	rehospitalization and must include instruction about:
89	89	(1) recognition of potential adverse health care
90	90	conditions;
91	91	(2) trip and fall avoidance;
92	92	(3) basic nutrition and cooking;
93	93	(4) medication prompting; and
94	94	(5) mobility and activity enhancement.
95	95	Sec. 533.104. INCREASED SUPERVISION AND COMPLIANCE. As a
96	96	component of the pilot program, the commission shall require a
97	97	participating provider agency to:
98	98	(1) increase supervision of the agency's personal care
99	99	attendants;
100	100	(2) implement stricter compliance protocols for
101	101	attendants; and
102	102	(3) at least quarterly conduct scheduled and
103	103	unscheduled visits to a recipient's home to confer with the
104	104	recipient about the personal care services the recipient is
105	105	receiving.
106	106	Sec. 533.105. FRAUD, WASTE, AND ABUSE PREVENTION PROTOCOLS.
107	107	As a component of the pilot program, the commission shall require a
108	108	participating provider agency to:
109	109	(1) develop enhanced fraud, waste, and abuse
110	110	prevention protocols that address collusion and fraud among
111	111	recipients, personal care attendants, and other provider agency
112	112	staff; and
113	113	(2) implement the protocols during a recipient's
114	114	enrollment, an agency's hiring process and employment reviews, and
115	115	other critical points in the delivery of personal care services.
116	116	Sec. 533.106. PERSONAL CARE ATTENDANT REGISTRY. The
117	117	commission, in consultation with participating provider agencies
118	118	and managed care organizations that contract with the commission to
119	119	provide health care services to recipients, shall establish as a
120	120	component of the pilot program a personal care attendant registry
121	121	that allows the commission to:
122	122	(1) track personal care attendant performance by
123	123	measuring recipient health outcomes; and
124	124	(2) identify each personal care attendant who fails to
125	125	meet certain standards, including following a participating
126	126	provider agency's implementation of progressive work improvement
127	127	efforts for the attendant.
128	128	Sec. 533.107. RECIPIENT TRANSFER PROTOCOLS. (a) As a
129	129	component of the pilot program, the commission shall require a
130	130	participating provider agency to develop and implement enhanced
131	131	recipient transfer protocols to:
132	132	(1) prevent a recipient and personal care attendant
133	133	from moving to a different provider agency in an effort to avoid
134	134	disciplinary action against or unfairly leverage a raise for the
135	135	personal care attendant;
136	136	(2) prevent fraud, waste, and abuse; and
137	137	(3) identify a poorly performing personal care
138	138	attendant.
139	139	(b) An enhanced recipient transfer protocol developed under
140	140	this section must allow a recipient to choose a provider agency.
141	141	Sec. 533.108. ENHANCED ELECTRONIC VISIT VERIFICATION
142	142	DEVICE COMPLIANCE. (a) As a component of the pilot program, the
143	143	commission shall require a participating provider agency to develop
144	144	and implement enhanced electronic visit verification device
145	145	compliance protocols to prevent fraud and waste due to an
146	146	attendant's reporting of hours that the attendant did not work.
147	147	(b) The commission shall meet with developers or providers
148	148	of electronic visit verification devices used by provider agencies
149	149	to explore additional options to counter fraud using the systems.
150	150	Sec. 533.109. ANTI-SOLICITATION AND ANTI-KICKBACK RULES.
151	151	The commission, in consultation with participating provider
152	152	agencies, shall determine as a component of the pilot program
153	153	strategies to strengthen anti-solicitation and anti-kickback rules
154	154	in order to prevent fraud and waste and improve the continuity of
155	155	care for recipients.
156	156	Sec. 533.110. ENHANCED PROVIDER AGENCY STANDARDS. The
157	157	commission, in consultation with participating provider agencies,
158	158	shall develop as a component of the pilot program stricter provider
159	159	agency standards to continually improve the delivery of home and
160	160	community support services. The standards must be outcome-based
161	161	and measured by recipient health outcomes or satisfaction.
162	162	Sec. 533.111. INCREASED ENFORCEMENT. (a) The commission,
163	163	in consultation with the commission's office of inspector general
164	164	and participating provider agencies, shall develop and implement:
165	165	(1) strengthened enforcement strategies for the pilot
166	166	program components; and
167	167	(2) effective strategies for provider agency
168	168	self-regulation with respect to the pilot program components and
169	169	other applicable requirements.
170	170	(b) The strategies must focus on:
171	171	(1) preventing fraud, waste, and abuse;
172	172	(2) eliminating from the Medicaid managed care program
173	173	the provider agencies and personal care attendants who have the
174	174	poorest performance;
175	175	(3) improving health care outcomes for recipients; and
176	176	(4) increasing savings for the state.
177	177	Sec. 533.112. MANAGED CARE ORGANIZATION PARTNERSHIPS. The
178	178	commission shall coordinate as a component of the pilot program
179	179	partnerships between participating provider agencies and managed
180	180	care organizations that contract with the commission to provide
181	181	health care services to recipients to improve the delivery of home
182	182	and community support services under the Medicaid managed care
183	183	program.
184	184	Sec. 533.113. REPORT. (a) Not later than September 1,
185	185	2021, the commission shall submit to the legislature a report
186	186	concerning the pilot program that includes:
187	187	(1) the results of any research related to the
188	188	program;
189	189	(2) the effectiveness of each component of the
190	190	program;
191	191	(3) any reports made by a participant or research
192	192	organization during the course of the program;
193	193	(4) other relevant information concerning the
194	194	program; and
195	195	(5) a recommendation about whether the pilot program
196	196	should be continued in whole or in part, expanded, or terminated.
197	197	(b) The commission shall provide the report prepared under
198	198	Subsection (a) to participating provider agencies and managed care
199	199	organizations.
200	200	Sec. 533.114. GIFTS, GRANTS, AND DONATIONS. The commission
201	201	may solicit and accept gifts, grants, and donations of any kind and
202	202	from any source for purposes of implementing this subchapter.
203	203	Sec. 533.115. RULES. The executive commissioner may adopt
204	204	rules necessary to implement this subchapter.
205	205	Sec. 533.116. EXPIRATION. This subchapter expires
206	206	September 1, 2023.
207	207	SECTION 2. Not later than January 1, 2018, the Health and
208	208	Human Services Commission shall establish the home and community
209	209	support services improvement pilot program as required by
210	210	Subchapter F, Chapter 533, Government Code, as added by this Act.
211	211	SECTION 3. If before implementing any provision of this Act
212	212	a state agency determines that a waiver or authorization from a
213	213	federal agency is necessary for implementation of that provision,
214	214	the agency affected by the provision shall request the waiver or
215	215	authorization and may delay implementing that provision until the
216	216	waiver or authorization is granted.
217	217	SECTION 4. This Act takes effect immediately if it receives
218	218	a vote of two-thirds of all the members elected to each house, as
219	219	provided by Section 39, Article III, Texas Constitution. If this
220	220	Act does not receive the vote necessary for immediate effect, this
221	221	Act takes effect September 1, 2017.