Texas 2019 - 86th Regular

Texas House Bill HB12 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	86R26795 KFF-D
1	2		By: Davis of Harris, Harless, Price, Zerwas, H.B. No. 12
2		-	Guerra, et al.
	3	+	et al.
	4	+	Substitute the following for H.B. No. 12:
	5	+	By: Miller C.S.H.B. No. 12
3	6
4	7
5	8		A BILL TO BE ENTITLED
6	9		AN ACT
7		-	relating to early childhood intervention and rehabilitative and
8		-	habilitative services.
	10	+	relating to early childhood intervention services.
9	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	12		SECTION 1. Section 73.009(a), Human Resources Code, is
11	13		amended to read as follows:
12	14		(a) The commission [department] shall develop and the
13	15		executive commissioner shall establish policies concerning
14	16		services described by this section. A child under three years of
15	17		age and the child's parent, guardian, or other legally authorized
16	18		representative [family] may be referred for services described by
17	19		this section if the child is:
18	20		(1) identified as having a developmental delay;
19	21		(2) suspected of having a developmental delay; or
20	22		(3) considered at risk of developmental delay.
21	23		SECTION 2. Chapter 73, Human Resources Code, is amended by
22	24		adding Sections 73.0111 and 73.012 to read as follows:
23	25		Sec. 73.0111. PROVIDER OMBUDSMAN. (a) In this section,
24	26		"ombudsman" means the individual designated as the ombudsman for
25	27		providers of services authorized under this chapter.
26	28		(b) The executive commissioner shall designate an ombudsman
27	29		for providers of services authorized under this chapter.
28	30		(c) The ombudsman's office is administratively attached to
29	31		the office of the ombudsman of the commission.
30	32		(d) The commission may use an alternate title for the
31	33		ombudsman in provider-directed materials if the commission
32	34		determines that the alternate title would benefit providers'
33	35		understanding of or access to ombudsman services.
34	36		(e) The ombudsman serves as a neutral party to assist
35	37		providers of services authorized under this chapter in resolving
36	38		issues related to providing early childhood intervention services
37	39		under this chapter, including through the STAR Kids managed care
38	40		program.
39	41		(f) The ombudsman shall:
40	42		(1) provide dispute and complaint resolution
41	43		services;
42	44		(2) perform provider protection and advocacy
43	45		functions;
44	46		(3) collect inquiry and complaint data; and
45	47		(4) at least annually, submit a report to the
46	48		commission relating to the inquiry and complaint data collected
47	49		under Subdivision (3) and make recommendations to the commission on
48	50		how to improve the provision of early childhood intervention
49	51		services under this chapter.
50	52		(g) The executive commissioner by rule shall adopt and
51	53		ensure the use of procedures for the reporting, monitoring, and
52	54		resolution of disputes and complaints described by Subsection (f)
53	55		that are consistent with the procedures adopted and used under
54	56		Medicaid.
55	57		Sec. 73.012. GUIDANCE ON REIMBURSEMENT METHODOLOGY FOR CASE
56	58		MANAGEMENT SERVICES. (a) The executive commissioner shall request
57	59		clear direction and guidance from the federal Centers for Medicare
58	60		and Medicaid Services on the reimbursement methodology that may be
59	61		used for the provision of case management services under this
60	62		chapter, including direction on allowable and unallowable costs.
61	63		(b) This section expires September 1, 2021.
62	64		SECTION 3. Subtitle B, Title 3, Human Resources Code, is
63	65		amended by adding Chapter 74 to read as follows:
64	66		CHAPTER 74. TELE-CONNECTIVE PILOT PROGRAM
65	67		Sec. 74.0001. DEFINITIONS. In this chapter:
66	68		(1) "Commission" means the Health and Human Services
67	69		Commission.
68	70		(2) "Education service center region" means a
69	71		geographic region served by a regional education service center
70	72		under Chapter 8, Education Code.
71	73		(3) "Eligible child" means a child who is eligible for
72	74		early childhood intervention services under Chapter 73.
73	75		(4) "Executive commissioner" means the executive
74	76		commissioner of the Health and Human Services Commission.
75	77		(5) "Tele-connective pilot program" means the program
76	78		developed and implemented under Section 74.0002.
77	79		(6) "Telehealth service" and "telemedicine medical
78	80		service" have the meanings assigned by Section 111.001, Occupations
79	81		Code.
80	82		Sec. 74.0002. TELE-CONNECTIVE PILOT PROGRAM. (a) The
81	83		commission shall develop and implement a pilot program to provide
82	84		early childhood intervention services under Chapter 73 to eligible
83	85		children through the provision of telehealth and telemedicine
84	86		medical services delivered using access points established in one
85	87		or more education service center regions selected for
86	88		implementation of the program. Access points may be established:
87	89		(1) at schools, regional education service centers,
88	90		and other entities located in an education service center region in
89	91		which the program is implemented;
90	92		(2) in home-based settings; and
91	93		(3) through other modes the commission determines
92	94		appropriate.
93	95		(b) In developing and implementing the tele-connective
94	96		pilot program, the commission shall ensure the program aligns with
95	97		the provision of existing telehealth and telemedicine medical
96	98		services.
97	99		Sec. 74.0003. EDUCATION SERVICE CENTER REGION SELECTION.
98	100		The commission in cooperation with the Texas Education Agency shall
99	101		select the education service center regions in which to implement
100	102		the tele-connective pilot program. In determining the regions in
101	103		which to implement the program, the commission and the Texas
102	104		Education Agency shall:
103	105		(1) consider each region in which there is:
104	106		(A) a low or inadequate number of service
105	107		providers authorized under Chapter 73; or
106	108		(B) a significant risk of losing service
107	109		providers authorized under Chapter 73; and
108	110		(2) implement the program only in regions in which the
109	111		implementation is reasonable and feasible.
110	112		Sec. 74.0004. PROVIDER PARTICIPATION. (a) The commission
111	113		shall ensure that all providers of services under Chapter 73,
112	114		including school districts, are allowed to participate as providers
113	115		in the tele-connective pilot program and provide services both
114	116		inside and outside a school-based setting.
115	117		(b) The commission shall track the service hours of
116	118		providers participating in the tele-connective pilot program.
117	119		Sec. 74.0005. ADEQUATE NETWORK OF ACCESS POINTS. (a) The
118	120		commission, in consultation with the Texas Education Agency, shall:
119	121		(1) establish any school-based provider access points
120	122		under the tele-connective pilot program; and
121	123		(2) ensure that an adequate number of school-based and
122	124		non-school-based access points are established in education
123	125		service center regions participating in the program.
124	126		(b) When selecting access points in which to implement the
125	127		tele-connective pilot program, the commission and the Texas
126	128		Education Agency shall consider the availability of existing
127	129		infrastructure.
128	130		Sec. 74.0006. AUTOMATIC AND VOLUNTARY PARTICIPATION OF
129	131		CERTAIN ELIGIBLE CHILDREN. (a) Subject to Subsection (b), the
130	132		executive commissioner shall, after receiving recommendations from
131	133		the advisory committee established under Section 73.004, by rule
132	134		establish which eligible children will be automatically enrolled in
133	135		the tele-connective pilot program.
134	136		(b) The parent, guardian, or other legally authorized
135	137		representative of an eligible child may, at any time, elect to opt
136	138		the child out of the tele-connective pilot program.
137	139		(c) A child who is enrolled in the tele-connective pilot
138	140		program may receive early childhood intervention services through
139	141		the program only to the extent the services are available and
140	142		suitable. Enrollment in the tele-connective pilot program does not
141	143		prevent a child from receiving early childhood intervention
142	144		services in the child's home or other natural environment.
143	145		Sec. 74.0007. SCHOOL DISTRICT EMPLOYEE TRAINING. The Texas
144	146		Education Agency shall develop a training course on the
145	147		tele-connective pilot program to be given to appropriate school
146	148		district employees.
147	149		Sec. 74.0008. INITIAL SCREENING AND EVALUATION. (a) The
148	150		parent, guardian, or other legally authorized representative of an
149	151		eligible child must be:
150	152		(1) present during an initial screening or evaluation
151	153		under the tele-connective pilot program; and
152	154		(2) given the opportunity to opt the child out of the
153	155		tele-connective pilot program at the time of the child's initial
154	156		screening or evaluation.
155	157		(b) Notwithstanding any other law, after a child is enrolled
156	158		in the tele-connective pilot program, early childhood intervention
157	159		services, including any initial treatment or prescription, that are
158	160		delivered or issued by a physician or by a health care provider
159	161		acting under the delegation or supervision of the physician or
160	162		under the health care provider's license may be provided using
161	163		telecommunications or other information technology.
162	164		Sec. 74.0009. PROVIDER REIMBURSEMENT. The executive
163	165		commissioner in adopting rules governing the tele-connective pilot
164	166		program shall ensure that provider reimbursement for a telehealth
165	167		or telemedicine medical service is made at a rate that is comparable
166	168		to the rate paid under Medicaid for the provision of the same or
167	169		substantially similar services.
168	170		Sec. 74.0010. CONFIDENTIALITY OF INFORMATION. The
169	171		commission shall ensure that the tele-connective pilot program
170	172		complies with federal and state law regarding confidentiality of
171	173		medical information, including the Health Insurance Portability
172	174		and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) and
173	175		the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.
174	176		Section 1232g).
175	177		Sec. 74.0011. ACCESS POINT EVALUATION. Not later than
176	178		September 1, 2020, the commission shall conduct an evaluation of
177	179		the tele-connective pilot program to ensure that an adequate number
178	180		of access points have been established in each education service
179	181		center region selected for implementation of the program. This
180	182		section expires January 1, 2021.
181	183		Sec. 74.0012. REPORT. Not later than January 1, 2021, the
182	184		commission shall submit an initial report to the governor, the
183	185		lieutenant governor, the speaker of the house of representatives,
184	186		and the presiding officers of the standing committees of the senate
185	187		and house of representatives having primary jurisdiction over the
186	188		early childhood intervention program authorized by Chapter 73. The
187	189		report must evaluate the operation of the tele-connective pilot
188	190		program and make recommendations regarding the continuation or
189	191		expansion of the program.
190	192		Sec. 74.0013. FUNDING. The commission shall actively seek
191	193		and apply for any available federal money to support the
192	194		tele-connective pilot program, including federal money made
193	195		available by the:
194	196		(1) Federal Communications Commission, including
195	197		money available under the federal Rural Health Care Program;
196	198		(2) United States Health Resources and Services
197	199		Administration's Office for the Advancement of Telehealth; and
198	200		(3) United States Department of Agriculture,
199	201		including the Distance Learning and Telemedicine Grant Program
200	202		established under 7 C.F.R. Part 1734.
201	203		Sec. 74.0014. EXPIRATION. This chapter expires September
202	204		1, 2023.
203	205		SECTION 4. Subchapter A, Chapter 302, Labor Code, is
204	206		amended by adding Section 302.0061 to read as follows:
205	207		Sec. 302.0061. WORKFORCE DEVELOPMENT GRANTS FOR PROVIDERS
206	208		UNDER EARLY CHILDHOOD INTERVENTION PROGRAM. (a) In this section,
207	209		"early childhood intervention program" means the program
208	210		established under Chapter 73, Human Resources Code, to provide
209	211		early childhood intervention services in accordance with Part C,
210	212		Individuals with Disabilities Education Act (IDEA)(20 U.S.C.
211	213		Section 1431 et seq.).
212	214		(b) The commission shall actively seek and apply for federal
213	215		funding to establish a program designed to provide workforce
214	216		development grants to providers participating in the early
215	217		childhood intervention program for purposes of improving the
216	218		provision of program services by offering providers appropriate
217	219		education and training.
218		-	SECTION 5. (a) The heading to Subchapter E, Chapter 1367,
219		-	Insurance Code, is amended to read as follows:
220		-	SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
221		-	DEVELOPMENTAL DELAYS
222		-	(b) Section 1367.201, Insurance Code, is amended to read as
223		-	follows:
224		-	Sec. 1367.201. DEFINITION. In this subchapter,
225		-	rehabilitative and habilitative therapies and related services
226		-	include:
227		-	(1) occupational therapy evaluations and services;
228		-	(2) physical therapy evaluations and services;
229		-	(3) speech therapy evaluations and services; [and]
230		-	(4) dietary or nutritional evaluations;
231		-	(5) specialized skills training by a person certified
232		-	as an early intervention specialist;
233		-	(6) applied behavior analysis treatment by a licensed
234		-	behavior analyst or licensed psychologist; and
235		-	(7) case management provided by a person certified as
236		-	an early intervention specialist.
237		-	(c) Section 1367.202, Insurance Code, is amended to read as
238		-	follows:
239		-	Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This
240		-	subchapter applies only to a health benefit plan that:
241		-	(1) provides benefits for medical or surgical expenses
242		-	incurred as a result of a health condition, accident, or sickness,
243		-	including an individual, group, blanket, or franchise insurance
244		-	policy or insurance agreement, a group hospital service contract,
245		-	or an individual or group evidence of coverage that is offered by:
246		-	(A) an insurance company;
247		-	(B) a group hospital service corporation
248		-	operating under Chapter 842;
249		-	(C) a fraternal benefit society operating under
250		-	Chapter 885;
251		-	(D) a stipulated premium company operating under
252		-	Chapter 884;
253		-	(E) a health maintenance organization operating
254		-	under Chapter 843; or
255		-	(F) a multiple employer welfare arrangement
256		-	subject to regulation under Chapter 846;
257		-	(2) is offered by an approved nonprofit health
258		-	corporation that holds a certificate of authority under Chapter
259		-	844; or
260		-	(3) provides health and accident coverage through a
261		-	risk pool created under Chapter 172, Local Government Code,
262		-	notwithstanding Section 172.014, Local Government Code, or any
263		-	other law.
264		-	(b) Notwithstanding any other law, this subchapter also
265		-	applies to a standard health benefit plan provided under Chapter
266		-	1507.
267		-	(d) Section 1367.203, Insurance Code, is amended to read as
268		-	follows:
269		-	Sec. 1367.203. EXCEPTION. (a) This subchapter does not
270		-	apply to:
271		-	(1) a plan that provides coverage:
272		-	(A) only for a specified disease or for another
273		-	limited benefit;
274		-	(B) only for accidental death or dismemberment;
275		-	(C) for wages or payments in lieu of wages for a
276		-	period during which an employee is absent from work because of
277		-	sickness or injury;
278		-	(D) as a supplement to a liability insurance
279		-	policy;
280		-	(E) for credit insurance;
281		-	(F) only for dental or vision care; or
282		-	(G) only for indemnity for hospital confinement;
283		-	(2) a small employer health benefit plan written under
284		-	Chapter 1501;
285		-	(3) a Medicare supplemental policy as defined by
286		-	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
287		-	(4) a workers' compensation insurance policy;
288		-	(5) medical payment insurance coverage provided under
289		-	a motor vehicle insurance policy; or
290		-	(6) a long-term care insurance policy, including a
291		-	nursing home fixed indemnity policy, unless the commissioner
292		-	determines that the policy provides benefit coverage so
293		-	comprehensive that the policy is a health benefit plan as described
294		-	by Section 1367.202.
295		-	(b) This subchapter does not apply to a qualified health
296		-	plan to the extent that a determination is made under 45 C.F.R.
297		-	Section 155.170 that:
298		-	(1) this subchapter requires the plan to offer
299		-	benefits in addition to the essential health benefits required
300		-	under 42 U.S.C. Section 18022(b); and
301		-	(2) this state is required to defray the cost of the
302		-	benefits mandated under this subchapter.
303		-	(e) Section 1367.204, Insurance Code, is amended to read as
304		-	follows:
305		-	Sec. 1367.204. PROVISION [OFFER] OF COVERAGE REQUIRED.
306		-	[(a)] A health benefit plan issuer must provide [offer] coverage
307		-	for rehabilitative and habilitative therapies and related services
308		-	in accordance [that complies] with this subchapter.
309		-	[(b) The individual or group policy or contract holder may
310		-	reject coverage required to be offered under this section.]
311		-	(f) Section 1367.205, Insurance Code, is amended by
312		-	amending Subsections (a) and (b) and adding Subsection (d) to read
313		-	as follows:
314		-	(a) A health benefit plan required to provide [that
315		-	provides] coverage for rehabilitative and habilitative therapies
316		-	and related services under this subchapter may not prohibit or
317		-	restrict payment for covered services provided to a child and
318		-	determined to be necessary to and provided in accordance with an
319		-	individualized family service plan issued by the Health and Human
320		-	Services Commission [Interagency Council on Early Childhood
321		-	Intervention] under Chapter 73, Human Resources Code.
322		-	(b) Rehabilitative and habilitative therapies and related
323		-	services described by Subsection (a) must be covered in the amount,
324		-	duration, scope, and service setting established in the child's
325		-	individualized family service plan.
326		-	(d) A health benefit plan prior authorization requirement,
327		-	or another requirement that a service be authorized, otherwise
328		-	applicable to a covered rehabilitative or habilitative therapy
329		-	service or a related service is satisfied if the service is
330		-	specified in a child's individualized family service plan.
331		-	(g) Subchapter E, Chapter 1367, Insurance Code, is amended
332		-	by adding Section 1367.2055 to read as follows:
333		-	Sec. 1367.2055. MEDICAID PAY PARITY. A health benefit plan
334		-	issuer shall reimburse a health care provider providing a
335		-	rehabilitative and habilitative therapy or related service at a
336		-	rate that is at least equal to the reimbursement rate the health
337		-	care provider would receive for providing the same or a
338		-	substantially similar service under Medicaid.
339		-	(h) Section 1367.206, Insurance Code, is amended to read as
340		-	follows:
341		-	Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
342		-	required to be provided [offered] under this subchapter, a health
343		-	benefit plan issuer may not:
344		-	(1) apply the cost of rehabilitative and habilitative
345		-	therapies and related services described by Section 1367.205(a) to
346		-	an annual or lifetime maximum plan benefit or similar provision
347		-	under the plan; or
348		-	(2) use the cost of rehabilitative or habilitative
349		-	therapies and related services described by Section 1367.205(a) as
350		-	the sole justification for:
351		-	(A) increasing plan premiums; or
352		-	(B) terminating the insured's or enrollee's
353		-	participation in the plan.
354		-	(i) Section 1367.207, Insurance Code, is amended to read as
355		-	follows:
356		-	Sec. 1367.207. RULES. (a) The commissioner may adopt rules
357		-	necessary to implement this subchapter.
358		-	(b) Section 2001.0045, Government Code, does not apply to a
359		-	rule adopted under this section.
360		-	(j) Subchapter E, Chapter 1367, Insurance Code, as amended
361		-	by this section, applies only to a health benefit plan delivered,
362		-	issued for delivery, or renewed on or after January 1, 2020. A
363		-	health benefit plan delivered, issued for delivery, or renewed
364		-	before January 1, 2020, is governed by the law as it existed
365		-	immediately before the effective date of this Act, and that law is
366		-	continued in effect for that purpose.
367		-	SECTION 6. (a) The Health and Human Services Commission
	220	+	SECTION 5. (a) The Health and Human Services Commission
368	221		shall request guidance from the federal Centers for Medicare and
369	222		Medicaid Services or other appropriate federal agency regarding the
370	223		feasibility of receiving a waiver or other authorization necessary
371	224		to provide through Medicaid early childhood intervention services
372	225		to children who are eligible to receive those services under
373	226		Chapter 73, Human Resources Code, as amended by this Act, but who
374	227		are not eligible for Medicaid and do not have private health
375	228		benefits coverage.
376	229		(b) As soon as practicable after receiving guidance under
377	230		Subsection (a) of this section, the Health and Human Services
378	231		Commission shall prepare a report on how best to provide to children
379	232		the coverage described by that subsection. The commission shall
380	233		submit the report to the governor, the lieutenant governor, the
381	234		speaker of the house of representatives, and the presiding officers
382	235		of the standing committees of the senate and house of
383	236		representatives having primary jurisdiction over the early
384	237		childhood intervention program authorized by Chapter 73, Human
385	238		Resources Code, as amended by this Act.
386		-	SECTION 7. (a) As soon as practicable after the effective
	239	+	SECTION 6. (a) As soon as practicable after the effective
387	240		date of this Act, the Health and Human Services Commission, after
388	241		consulting with the Texas Education Agency, other appropriate state
389	242		agencies, and the advisory committee established under Section
390	243		73.004, Human Resources Code, shall conduct a financial evaluation
391	244		of the early childhood intervention services provided under Chapter
392	245		73, Human Resources Code, as amended by this Act, and report on that
393	246		evaluation. The report must quantify the amount by which providing
394	247		early childhood intervention services in this state affects other
395	248		budget strategies, including the budget strategies of school
396	249		districts, regional education service centers, and other affected
397	250		governmental entities.
398	251		(b) Not later than September 1, 2020, the Health and Human
399	252		Services Commission shall submit the report prepared under
400	253		Subsection (a) of this section to the governor, the lieutenant
401	254		governor, the speaker of the house of representatives, and the
402	255		presiding officers of the standing committees of the senate and
403	256		house of representatives having primary jurisdiction over the early
404	257		childhood intervention program authorized by Chapter 73, Human
405	258		Resources Code, as amended by this Act.
406		-	SECTION 8. Not later than December 1, 2019, the Health and
	259	+	SECTION 7. Not later than December 1, 2019, the Health and
407	260		Human Services Commission shall issue guidance to health benefit
408	261		plan issuers clarifying that providers of early childhood
409	262		intervention services under Chapter 73, Human Resources Code, as
410	263		amended by this Act, must file claims using the national provider
411	264		identifier number and Texas provider identifier number.
412		-	SECTION 9. As soon as practicable after the effective date
	265	+	SECTION 8. As soon as practicable after the effective date
413	266		of this Act, but not later than January 1, 2020, the Health and
414	267		Human Services Commission shall develop and implement the
415	268		tele-connective pilot program required by Chapter 74, Human
416	269		Resources Code, as added by this Act.
417		-	SECTION 10. If before implementing any provision of this
418		-	~~Act~~ a state agency determines that a waiver or authorization from a
	270	+	SECTION 9. If before implementing any provision of this Act
	271	+	a state agency determines that a waiver or authorization from a
419	272		federal agency is necessary for implementation of that provision,
420	273		the agency affected by the provision shall request the waiver or
421	274		authorization and may delay implementing that provision until the
422	275		waiver or authorization is granted.
423		-	SECTION 11. This Act takes effect September 1, 2019.
	276	+	SECTION 10. This Act takes effect September 1, 2019.